Clinical Examination, Duplex Ultrasound and Plethysmography for Varicose Veins

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Abstract
Objective: In pursuing a policy of selective greater saphenous vein (GSV) preservation in the treatment of varicose veins we hypothesized that limbs with isolated tributary disease (TD) would be ideal candidates for GSV preservation. Design: Prospective blinded series. Setting: University teaching hospital. Patients: Fifty-nine symptomatic legs in 45 consecutive patients presenting with varicose veins. Interventions: Patients were evaluated by physical examination, quantitative photoplethysmography (QPG) and colour flow duplex examination. Main outcome measure: Colour flow duplex as the standard of comparison. Results: Of the limbs studied, 29% had isolated TD. The sensitivity of physical examination for GSV incompetence was 43%, but specificity was 100%. QPG yielded a similar sensitivity of 24% and specificity of 100%. Conclusions: Twenty-nine per cent of limbs were optimal candidates for sparing of the GSV with excision of branch varicosities alone. Duplex examination was necessary only when the GSV was clinically normal, and QPG was not helpful.