History: focus on understanding the natural history of the patient’s disease, including symptoms, their duration and progression over time. Complications of VV or CVI, risk factors for development of CVD, risk factors for serious causes/complications (spontaneous bleeding, open/non healing ulcers) need to be identified, prioritised and co-managed in any management plan.
Examination [4,11]: modern physical examination is focused on identifying the severity of clinical manifestation of VV and CVI, from simple telangiectasia to ulcer formation, and the distribution of disease, GSV, SSV and/or perforator veins. Examination should be conducted in the standing position with full examination of both legs from the groin to the foot, from all aspect of the legs front/back/both sides. Historical clinical tests to distinguish the location along the leg and involvement of deep or superficial system, such as Brodie-Trendelenberg and Perthes Tests, are still taught. However the diagnostic availability and accuracy of ultrasound imaging has replaced these clinical tests in modern venous surgical practice.
Doppler Ultrasonography [4, 11]: Venous duplex ultrasound has become the standard of care in the diagnostic imaging for disease of both the deep and superficial systems. This is best done with the patient in a warm environment and in the standing position. Most modern surgical/venous treatment practices utilise specialist venous ultrasonography to assess:
- Patency and competency of the superficial system including the segments of venous incompetence, the diameter of the GSV & SSV along their length, site of junctions and perforator veins.
- The saphenofemoral junction, its competence and relationships
- Presence of any extrinsic compression, most commonly found around the SSV at the popliteal-saphenojunction
- Patency and competency of the deep system
- The underlying cause of the CVD
