DOPPLER US OF THE EXTREMITY

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Role of color Doppler ultrasonography for the evaluation ofvulvar varicesJin KN, Lee W, Cho YK, Jung JW, Park JH, Seoul NationalUniversity Hospital, Korea; Seoul National University College ofMedicine, Korea

Objectives: To reveal the diagnostic role of color Doppler ultrasonog-raphy to demonstrate vulvar varices arising from the pelvic vein andexclude other cause of vulvar varices.Methods: Sixty patients underwent CT venography for the vulvoperi-neal varices; nine of them with vulvar varices and atypical varicoseveins on the medial side of the upper thighs were selected for theultrasonography to demonstrate venous reflux of vulvar varices fromthe pelvic vein. Color Doppler and pulsed-wave Doppler ultrasonog-raphy were enrolled to detect perforators and to estimate direction andflow rate of venous reflux. Valsalva maneuver was used to provoke thevenous reflux.Results: In nine patients who had vulvar varices communicating withthe atypical varicose veins on the medial side of the upper thigh, colorDoppler ultrasonography demonstrated venous reflux from the pelvicvein and could exclude saphenofemoral insufficiency.Conclusions: Vulvoperineal varices have different causes such aspelvic vein insufficiency, saphenofemoral insufficiency or post-throm-botic syndrome. Careful color Doppler ultrasonography is the appro-priate noninvasive means to establish diagnosis of vulvar varices aris-ing from the pelvic vein and rule out saphenofemoral insufficiency.

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Varicose veins of the lower extremity: Color Doppler ultrasoundstudy for incompetent sapheno-femoral junction, sapheno-popliteal junction and perforating veinsKim SK, Hong SJ, Park CM, Cha IH, Kim HJ, Korea UniversityGuro Hospital, Korea

Objectives: We evaluated the incidence and severity of incompetentsapheno-femoral junction (SFJ), sapheno-popliteal junction (SPJ) andperforating veins (PVs) by color Doppler ultrasound (CDUS) in pa-tients with varicose veins of the lower extremity.Methods: On CDUS, varicose veins were demonstrated in 346 lowerextremities of 241 patients. There were 96 men and 145 women with meanage 50 (range 11 to 74). CDUS was focused on the incompetence at SFJ,SPJ, and PVs. The severity of SFJ and SPJ incompetence were graded asI (minimal) to IV (severe). SFJ was evaluated on supine and standingpositions with and without Valsalva’s maneuver. SPJ was evaluated onprone and standing positions with and without Valsalva’s maneuver.Distension or reflux was considered as a sign of incompetent PVs.Results: SFJ incompetence was noted in 198 (57.2%) cases, SPJincompetence in 81 and incompetence of both SFJ and SPJ in 21.Incompetent PVs was seen in 54. No incompetence was demonstratedin 34 (9.8%). Among SFJ incompetence, 75 were in grade II, 73 werein grade III. Among SPJ incompetence, grade III was most common.Conclusions: SFJ incompetence is a major cause of varicose veins inlower extremity. Varicose veins can be present without incompetenceat SFJ, SPJ, PVs.

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Duration and velocity of reflux obtained by color Doppler asprognostic criteria of chronic venous insufficiencyGoldina IM, Trofimova EY, Kungurtsev EV, N.V. SklifosovskyResearch Institute of Emergency Medical Aid, Moscow, RussianFederation

Objectives: Duration and peak velocity of the reflux at the sapheno-femoral junction (SFJ) were investigated in patients with chronicvenous insufficiency (CVI) according to the CEAP (clinical, etiologic,anatomic, pathophysiologic) clinical classification to determine prog-nostic value of the ultrasound (US) diagnostic criteria.Methods: Color Doppler (CD) and Valsalva’s maneuver have per-formed to determine the incompetence of SFJ in patients with differentclinical classes of CVI according classification CEAP. The clinicalseries contained 174 patients (254 extremities), control group was 26patients (52 extremities).Results: It was obtained that 118 (170 lower extremities) patients withclinical signs of CVI were possesed SFJ failure. The duration of thereflux was more 0.5 sec. The duration of the reflux positive prognosticvalue was 0.98 (Se: 0.68, Sp: 0.94, r � 0.9657, p � 0.001). Mean valueof peak velocity of reflux at the SFJ was from 14.8 � 3.5 cm/s (C0clinical class of CVI) to 68.4 � 4.1 cm/s (C5 clinical class of CVI).Peak velocity positive prognostic value was 0.9 (Se: 0.9, Sp: 0.78, p �0.001).Conclusions: Duration and velocity reflux criteria are better predictorsof the progression of chronic venous insufficiency and that they cor-relate well with the severity of the clinical manifestation of chronicvenous insufficiency.

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Revisiting the significance of monophasic waveforms on DVTevaluationLin E, Bhatt S, Ormanoski M, Rubens D, Dogra V, Strong MemorialHospital, United States of America

Objectives: Assess the significance of monophasic waveforms in thecommon femoral veins in deep venous thrombosis (DVT).Methods: Lower extremity venous Doppler ultrasounds (US) per-formed at Strong Memorial Hospital from 1 September 2003 through 1September 2005 were reviewed retrospectively. Studies, meeting theAIUM criteria, were evaluated for monophasic waveforms, and correl-ative studies were reviewed. Patients less than the age of 17 wereexcluded from the study.Results: One thousand thirteen lower extremity venous Doppler USexaminations were reviewed; 59 of these studies demonstratedmonophasic waveforms, of which 41 had additional CT examinationsof the abdomen and pelvis within 1 week, 9 within 2 months, 5 with noadditional exams; 23/59 cases revealed DVT above the level of thecommon femoral vein, of which six were identified by US; 7/59 weredue to extrinsic compression. 26/59 had no apparent cause formonophasic waveforms; 3/59 were secondary to hypoplastic commoniliac veins.Conclusions: Two fifth of the cases with monophasic waveformsdemonstrated DVT above the level of the common femoral veins. Werecommend including Doppler examination of the external iliac veinsin patients who exhibit monophasic waveforms. A prospective studyshould be undertaken to further evaluate the role of adjunctive CTstudies in patients with unexplained monophasic waveforms.

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Role of ultrasound in evaluation of unilateral leg swellingShaukat A, Mayo Hospital, Lahore, Pakistan

Objectives: To know the effectiveness of high resolution USG inevaluation of unilateral leg swelling.Methods: 7–10 MHz transducer, patients with unilateral leg swelling,time of study June 2004 to November 2005; 314 patients, exclusionalready diagnosed cases.

Abstracts P127