Campbell W B, Halim A S, Aertssen A, Ridler B M, Thompson J F, Niblett P G
Department of Surgery, Royal Devon and Exeter Hospital, Wonford.
Ann R Coll Surg Engl. 1996 Nov;78(6):490-3.
Duplex scanning has become the 'gold standard' for confirming reflux and demonstrating anatomy in cases of lower limb venous disease. However, the large numbers of patients presenting with varicose veins (or with skin changes and ulcers) mean that routine use of duplex is impractical, and this investigation has still not become well established in many hospitals. In order to determine the proportion of patients likely to require duplex scanning (and other special tests-photoplethysmography and ascending venography) we reviewed a consecutive series of 201 patients referred to the vascular clinic of a district general hospital with 283 symptomatic limbs affected by varicose veins and/or skin changes and ulcers. Patients were examined clinically and with hand-held Doppler. Duplex scanning was then requested to check for reflux in the popliteal fossa and to examine the groin and residual long saphenous vein in some cases of recurrent varicose veins. Duplex scanning was required in 51 (18%) limbs, venography in 8 (3%), and photoplethysmography in only one limb. In total, special tests were needed in 60 (21%) limbs. Subsequently, 198 (70%) limbs were referred for surgery. We would now (in 1996) duplex scan every case with popliteal fossa reflux and most recurrences. Had all these been scanned, then 79 (28%) would have had special tests. This knowledge should help in planning the implications of a duplex scanning service for varicose veins, skin changes and ulcers.
双功超声扫描已成为确诊下肢静脉疾病反流和显示解剖结构的“金标准”。然而，大量患有静脉曲张（或伴有皮肤改变和溃疡）的患者意味着常规使用双功超声并不实际，而且这项检查在许多医院仍未得到广泛应用。为了确定可能需要双功超声扫描（以及其他特殊检查——光电容积描记法和上行静脉造影）的患者比例，我们回顾了连续收治的201例转诊至一家地区综合医院血管门诊的患者，这些患者有283条肢体出现静脉曲张和/或皮肤改变及溃疡症状。对患者进行了临床检查和手持多普勒检查。然后要求进行双功超声扫描，以检查腘窝处的反流情况，并在某些复发性静脉曲张病例中检查腹股沟和残留的大隐静脉。51条（18%）肢体需要进行双功超声扫描，8条（3%）肢体需要进行静脉造影，只有1条肢体需要进行光电容积描记法检查。总共60条（21%）肢体需要进行特殊检查。随后，198条（70%）肢体被转诊进行手术。我们现在（1996年）会对每例有腘窝反流和大多数复发性病例进行双功超声扫描。如果对所有这些病例都进行了扫描，那么79例（28%）将会进行特殊检查。这些信息有助于规划针对静脉曲张、皮肤改变和溃疡的双功超声扫描服务的意义。
