Chronic venous insufficiency refers to venous valvular incompetence in superficial, deep, and perforating veins

Venous reflux that persists for longer than 0.5 s at any level is considered clinically significant

Grayscale ultrasound : Evaluate definition of vein lumen, vein valve leaflets, and wall morphology

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  Evaluate compressibility of vein and echogenicity of thrombus, which may indicate chronicity

Pulsed Doppler : Differentiate venous from arterial flow

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  Assess duration of venous reflux

  
  
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  Assess augmentation with distal limb compression (use contralateral limb as reference)

  
  
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  Evaluate reflux in deep vs. superficial veins at saphenofemoral junction and saphenopopliteal junction

  
  
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  Identify incompetent perforating veins

Color Doppler : Differentiate partial thrombosis from complete venous occlusion

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  Distinguish reflux in deep veins from reflux in superficial system at saphenofemoral junction and saphenopopliteal junction

  
  
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  Identify incompetent perforating veins

  
  
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  Demonstrate recanalization of chronically thrombosed venous segment and collateralization around thrombosed veins

At each level, evaluate for the following

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  Cephalad flow when limb compressed distally

  
  
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  No retrograde flow with release of distal compression with Valsalva maneuver or with limb compression proximal to probe

Calf arterial perforator

Great saphenous vein steal

Baker cyst

Minimally invasive procedure performed as outpatient or day case procedure

Radiofrequency ablation or laser ablation of great saphenous vein

Conventional surgery

Optimize color flow imaging parameters for detection of low-velocity flow

When venous insufficiency suggested in recumbent ultrasound, confirm by moving patient to standing position