Baldt M M, Böhler K, Zontsich T, Bankier A A, Breitenseher M, Schneider B, Mostbeck G H
Department of Radiology, University of Vienna Medical School, Austria.
J Ultrasound Med. 1996 Feb;15(2):143-54. doi: 10.7863/jum.1996.15.2.143.
We prospectively examined 137 limbs in 112 consecutive patients with clinical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evaluate the diagnostic capabilities of color coded duplex sonography in the assessment of venous anatomy, variant varicosis, postthrombotic changes, and incompetence of the superficial and perforating venous system. Additionally, descending venography was performed in the first 52 limbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending venography compared to surgery. Color coded duplex sonography was inconclusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded duplex sonography. Color coded duplex sonography was inconclusive in five cases. Ascending venography was slightly superior to color coded duplex sonography in the detection of postphlebitic changes. Good agreement was found between color coded duplex sonography and descending venography in the grading of superficial (k = 0.75) and deep venous reflux (k = 0.79). Excellent agreement was found between ascending venography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforating veins were detected by ascending venography, (and varicography) than by color coded duplex sonography, but the latter technique allows direct preoperative marking of the skin, which is beneficial for the surgeon. We conclude that color coded duplex sonography is a valuable imaging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous anatomy) should proceed to venography.
我们对112例连续患有严重静脉曲张临床证据的患者的137条肢体进行了前瞻性研究，采用彩色编码双功超声和上行静脉造影（48条肢体包括静脉造影）来评估彩色编码双功超声在评估静脉解剖结构、变异静脉曲张、血栓形成后改变以及浅静脉和穿通静脉系统功能不全方面的诊断能力。此外，对最初的52条肢体进行了下行静脉造影，并与彩色编码双功超声在深静脉和浅静脉反流诊断方面进行了比较。与手术相比，上行静脉造影在两例中漏诊了变异静脉解剖结构（21例），在一例中出现了错误解读。彩色编码双功超声在两例中结果不明确。静脉造影在7例手术证实的变异静脉曲张病例中漏诊，彩色编码双功超声在1例中漏诊。彩色编码双功超声在5例中结果不明确。上行静脉造影在检测血栓形成后改变方面略优于彩色编码双功超声。在浅静脉反流分级（k = 0.75）和深静脉反流分级（k = 0.79）方面，彩色编码双功超声与下行静脉造影之间发现了良好的一致性。在大隐静脉（k = 0.96）和小隐静脉反流分级（k = 0.94）方面，上行静脉造影之间发现了极好的一致性。上行静脉造影（和静脉造影）比彩色编码双功超声检测到更多功能不全的穿通静脉，但后一种技术允许在术前直接标记皮肤，这对外科医生是有益的。我们得出结论，彩色编码双功超声是静脉剥脱术前一种有价值的成像工具，能够替代有创的上行和下行静脉造影。只有彩色编码双功超声结果不明确的患者（例如，复杂的变异静脉解剖结构）才应进行静脉造影。
