Adequate and accurate investigation of the venous hemodynamics of the lower limb

Abstract

Investigation of the deep venous system of the lower limb must mainly aim to elucidate its capabilities. Because deep venous incompetence is necessarily connected with a popliteal reflux accounted for by valvular incompetence of the popliteal vein, its presence must be clarified. Priority is given to the noninvasive Doppler ultrasound and/or duplex, and the investigation can be continued by venous pressure measurements and phlebography only when required. An operation in the deep veins is admissible only when a popliteal reflux of more than 40%, an ambulatory venous pressure of more than 60 mm Hg, a refilling time less than fifteen seconds, a venous insufficiency of more than 20%, and a patency or recanalization of the deep veins of more than 70% have been confirmed. A correlation between venous pressure and Doppler recordings has been done. In a series of 81 patients (103 limbs) operated on during the last five years, the selection for operation was made successfully only by Doppler ultrasound, as demonstrated by the results obtained after the substitute valve operation by Technique II.