title: Preoperative duplex imaging is required before all operations for primary varicose veins.
abstract: BACKGROUND
  Physical examination is unreliable in the detection of sources of reflux in varicose veins. Hand-held Doppler (HHD) ultrasonography has been recommended as an accurate adjunct to physical examination. The aim of this study was to evaluate the accuracy of HHD imaging in comparison with duplex ultrasonography.
  
  
  METHODS
  Eighty-nine legs in 61 patients with primary varicose veins were examined with an HHD probe to detect reflux at the saphenofemoral junction (SFJ), the saphenopopliteal junction (SPJ) and in thigh perforators (TPs). Patients then underwent duplex imaging and the results of the tests were compared.
  
  
  RESULTS
  The sensitivity of the HHD technique was 73 per cent at the SFJ, 77 per cent at the SPJ and 51 per cent for TPs. In primary varicose veins the surgery planned using HHD imaging alone would have left residual sites of reflux in 24 per cent.
  
  
  CONCLUSIONS
  Examination with HHD ultrasonography is not sufficiently accurate to plan varicose vein surgery. Duplex imaging is recommended before all operations for primary varicose veins.
authors.affiliation: Department of Vascular, St James's and Seacroft University Hospital NHS Trust, Leeds, UK.
authors.forename: K G
authors.initials: KG
authors.lastname: Mercer
authors.forename: D J
authors.initials: DJ
authors.lastname: Scott
authors.forename: D C
authors.initials: DC
authors.lastname: Berridge
mesh_terms: D006801:Humans; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D018616:Ultrasonography, Doppler, Duplex / Q000295:instrumentation; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000601:surgery*