Wills V, Moylan D, Chambers J
Port Macquarie Base Hospital, New South Wales, Australia.
Aust N Z J Surg. 1998 Jan;68(1):41-4. doi: 10.1111/j.1445-2197.1998.tb04635.x.
Clinical assessment has been shown to compare poorly with results of hand-held Doppler examination or venography in the evaluation of varicose veins. Although the use of duplex scanning has been well described in the assessment of varicose veins, there are few data comparing clinical and Doppler assessment with results of duplex scans.
A total of 188 patients were referred with varicose veins to a sole specialist vascular surgeon over a 1-year period. After clinical and Doppler assessment, all patients were referred for a duplex scan which was performed by a trained vascular technician. The results of the duplex scan were compared retrospectively with the clinical and Doppler findings.
A total of 315 legs were assessed over this period, with 38.7% having recurrent disease and 31.4% having trophic skin changes or ulceration. On duplex scanning, 198 legs (62.9%) had saphenofemoral junction incompetence, 61 legs (19.4%) had saphenopopliteal junction incompetence, 94 legs (29.8%) had perforator incompetence and 24 legs (7.6%) had deep venous incompetence. The respective sensitivity of clinical and Doppler assessment at these sites was 71.2, 36.1, 43.6 and 29.2%. If patients who were felt to have sole saphenofemoral junction incompetence clinically were treated by high ligation, stripping to the knee and stab avulsions, 28.9% would have had sites of reflux untreated.
Clinical and Doppler assessment is unreliable. Routine duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.
在评估静脉曲张时，临床评估已被证明与手持多普勒检查或静脉造影的结果相比效果不佳。尽管在静脉曲张评估中双功扫描的应用已有详尽描述，但很少有数据将临床和多普勒评估与双功扫描结果进行比较。
在1年时间里，共有188例静脉曲张患者被转诊至一位血管外科专科医生处。在进行临床和多普勒评估后，所有患者均被转诊接受由训练有素的血管技术人员进行的双功扫描。双功扫描结果与临床和多普勒检查结果进行回顾性比较。
在此期间共评估了315条腿，其中38.7%有复发性疾病，31.4%有营养性皮肤改变或溃疡。双功扫描显示，198条腿（62.9%）存在大隐静脉-股静脉交界处功能不全，61条腿（19.4%）存在小隐静脉-腘静脉交界处功能不全，94条腿（29.8%）存在穿通支功能不全，24条腿（7.6%）存在深静脉功能不全。临床和多普勒评估在这些部位的各自敏感性分别为71.2%、36.1%、43.6%和29.2%。如果临床上被认为仅存在大隐静脉-股静脉交界处功能不全的患者接受高位结扎、剥脱至膝部和点状剥脱治疗，28.9%的反流部位将未得到治疗。
临床和多普勒评估不可靠。常规双功扫描可能通过更准确地识别反流部位来降低复发率。
