Investigations

1st investigations to order

duplex ultrasound

Test
Result
Test

These results indicate venous reflux.

Duplex ultrasound imaging combines B (brightness)-mode imaging and Doppler interrogation. It is the initial and most important primary diagnostic study. It can localise sites of obstruction and valvular reflux in both the deep and superficial venous systems. It should be noted that duplex ultrasound is operator dependent and that a reflux study must be performed and not merely an examination for acute deep vein thrombosis.​​[2][10]​

Result

retrograde or reversed flow, valve closure time >0.5 seconds

Investigations to consider

ascending phlebography

Test
Result
Test

Supplanted by duplex imaging, except when used by a specialist to evaluate treatment options for complex cases of CVI, such as those involving iliac vein obstruction.​​[2][10]

Result

identifies obstruction site and level, presence, and location of collaterals

CT venography

Test
Result
Test

Provides excellent anatomical detail, so is useful in evaluating congenital and complex or advanced CVI.​​[2][10]

Result

reveals detailed venous anatomy

magnetic resonance venography

Test
Result
Test

Provides excellent anatomical detail, so is useful in evaluating congenital and complex or advanced CVI.​​[2][10]

Result

reveals detailed venous anatomy

CT abdomen and pelvis

Test
Result
Test

Used to rule out extrinsic compression as a cause for iliac vein compression.​​[2][10]

Result

may reveal pelvic or abdominal mass in iliac vein obstruction

abdomen and pelvis ultrasound

Test
Result
Test

Used when there is suggestion of iliac vein obstruction.[2][17]

Result

may reveal pelvic or abdominal mass

intravascular ultrasound

Test
Result
Test

Used in specialised centres as a secondary test to evaluate the significance of iliac vein obstruction in complex cases of CVI and is extremely useful in the diagnosis and therapy of iliac vein disease.[2]​[10]​​

Result

reveals venous anatomy

air plethysmography

Test
Result
Test

Non-invasive investigation assessing venous function. Primarily used for research. Not frequently used outside of highly specialised centres or research settings.[2]​[10]​​

Result

identifies reflux and obstruction

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