Ultrasound guided foam sclerotherapy (UGFS) is an established technique which uses ultrasound to map the direction of foam and gauge the amount required for venous closure. Contrast guided foam sclerotherapy (CGFS) is used for similar indications. However, the images provide greater detail on the behaviour of the injected foam. The amount of foam and the… Read More »
It is often stated that ultrasound competence of the terminal valve (TV) with incompetence of the pre-terminal valve (PTV) indicates that the source of great saphenous vein (GSV) reflux is from pelvic veins. In consequence, ligation of the sapheno-femoral junction alone will not prevent reflux of pelvic origin from entering the lower segments of the… Read More »
Recalcitrant ulcers in the ambulant patient are those which do not heal after all the conventional treatments have been exhausted. These include the abolition of reflux sources and the diligent use of compression bandaging. In these cases there are two invasive options: shaving and fasciectomy. Shaving involves tangential paring of the ulcer down to fresh… Read More »
Pelvic venous reflux (PVR) may cause prolonged pressurisation of the veins in the pelvis. This can result in pelvic congestion syndrome (PCS) with non-cyclical pain or a constant dull ache, exacerbated standing or sitting, for over 6 months. It may be associated with dyspareunia and haemorrhoids. If the reflux escapes into the leg it may… Read More »
In 1977, Mauro Bartolo proposed a technique for the non-invasive measurement of venous pressure which he termed the venous pressure index (VPI). This is performed standing with a flat or cylindrical duplex probe of 8 MHz which may be fixed in position over an ankle vein (GSV, SSV or posterior tibial vein). A pneumatic cuff… Read More »
The conventional treatment for venous ulcers is with graduated compression bandages. They work by improving the calf-muscle pump and by augmenting venous tone, both which facilitate venous drainage. In an effort to standardise the degree of compression achieved, bandages have been developed with ink patterns on the surface. When stretched on a patient the patterns… Read More »