Clinical manifestation of venous diseases involves screening and diagnosis to determine the extent of symptoms, physical examination to look for swelling, skin changes, varicose veins or ulcers on the leg. However, to confirm the diagnosis, to determine variation in etiology such as reflux, obstruction or hypertension, to localize the anatomic site and extent of disease or identify coexisting vascular disorders, objective testing and screening are needed. Diagnostic testing enables identification of patients with venous pathology possibly to benefit from vein ablation treatments, which positively control vein-related symptoms and decrease the incidence of recurrent ulceration in those with superficial venous reflux.
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The advent of diagnostic tests with non-invasive techniques to evaluate patients with suspected chronic venous insufficiency have assumed an increasingly important role in the management of patients with vascular diseases.
These techniques have been applied for :
- screening asymptomatic individuals
- diagnosis of symptomatic patients
- monitoring of interventional or surgical procedures
- follow-up of the natural history/efficacy of medical, interventional or surgical therapy
Application of non-invasive instruments and tools allows for objective evaluation of vascular disorders by:
- the measurement of segmental limb blood pressures
- analysis of blood velocity disturbances
- recording of digit or limb pulse waveforms
- imaging of vascular diseases
- Doppler flow analysis or color-flow mapping
Certain diagnostic imaging tests include:
Duplex Ultrasound – is a combination of Doppler and conventional ultrasound that can produce 2D moving images of blood. This helps determine the directional flow of blood in superficial blood vessels and rule out the presence of Deep Vein Thrombosis.
The 30 to 60 minutes procedure involves a handheld device called a transducer passed against the skin through a medium of warm gel placed over the area covering the vein. The transducer transmits sound waves that depict images of blood vessels on the computer screen.
Magnetic Resonance Venogram – is similar to MRI scan where radio waves are used to create images and detect blood flow and obstruction even in deep veins of the leg. After local anesthetic is applied to the arm, an IV with a contrast dye injected in to it highlights blockages or valve disorders on the system monitor. This procedure normally takes about 1 hour.
CT venogram – makes use of a series of X-rays and computer software to detect blood flow and clots in the deep veins of the legs. A contrast dye is injected into a vein to mark and monitor blood flow on a computer screen. This is approximately a 45-minute-long procedure.
Venogram – X-rays and a contrast dye are used to create images of leg veins. Blood clots or pooling can be checked. This test is less commonly applied and takes about 60 minutes to conduct. During this test, a contrast dye is injected into the IV which may give a warm or burning sensation as the dye flows into the vein. The dye shows blockages or valve problems on a computer screen.
Infrared Thermography – Body temperature is used as a parameter for diagnosing peripheral vascular diseases. Temperature gradients observed at vascular disorder regions indicate abnormal blood flow. Thermal imaging results are well correlated with the clinical findings. Inflammation and underlying venous flow changes show increased temperature profiles in certain regions of the affected limb. In general, the observed temperature contrast in the affected regions is about 0.7 to 1° C above the normal regions, due to sluggish blood circulation.