Comparison of different examinatıon positions at colored Doppler sonography of lower extremity venous insufficiency

In our study, our goal was to compare the results of colored doppler sonography of lower extremity veins, performed with valsalva manoeuvre in standing versus in supine position and correlate the results with patient?s clinical statusStudy population was comprised of 100 patients referred to our clinic for venous insufficiency suspicion and 25 healthy volunteers.Total 250 legs were investigated. Patients were classified according to CEAP classification. 65 patients considered as C0 and C1 were included in Group A. 35 patients considered C2 or above were included in group B. Group C was comprised of 25 healthy volunteers Reflux above 500 msc. was considered pathologic. Results were compared with T test for every vein segmentAt group A, the rate of legs that there was no reflux in standing, while reflux was present in supine position were 83 out of 107 (77.5%) for common femoral vein (CFV), 18 out of 29 (62%) for superficial femoral vein (SFV), and 25 out of 30 (83.3%) for deep femoral vein (DFV). At group B, rates were 18 out of 30 (62%) for CFV, 9 out of 14 (64.2%) for SFV and 7 out of 7 (100%) for DFV. At group C, these rates were 23out of 30 (76.6%) for CFV, 4 out of 4 (100 %) for SFV and 4 out of 4 (100%) for DFV. At group A, rates were 9 out of 23 (39%) for great saphenous vein (GSV) proximal segment and 8 out of 20 (40%) GSV distal segment. At group B, out of 32 legs that reflux was present in supine, there was only 1 (3.1%) leg that there was no reflux in standing for GSV proximal segment and 1 out of 30 (3.3%) for GSV distal segment. At group A, no reflux was found in 128 (81.6%) legs in supine for SFV. Of these 128 legs, no reflux was present in 119 (92.9%) in standing either. These rates were 48 out of 50 (96%) for CFV, 123 out of 127 (96.8%) for DFV, 129 out of 134 (96.2%) for GSV proximal and 132 out of 137 (96.3%) for GSV distal segment. At group B, rates were 10 out of 13 (76.9%) for CFV, 26 out of 29 (89.6%) for SFV, 33 out of 36 (91.6%) for DFV, 10 out of 11 (90.9%) for GSV proximal and 9 out of 13 (69.2%) for GSV distal segment. These rates showed a significant increase at control group C. 19 out of 20 (95%) for CFV, 43 out of 46 (93.5%) for SFV, 45 out of 46 (97.8%) for DFV, 45 out of 45 (100%) for GSV proximal and distal segment were foundIn conclusion, determining the patient clinical stage before starting a colored doppler sonography for a patient with CVD prediagnosis will probably decrease the need for examining the patient in standing, especially when no reflux is found and reflux is found at GSV in supine, since there is no significant difference between both positions. However, we also recommend that deep venous system veins, particularly CFV should be examined in standing, when reflux is present in supine in order to prevent false positive results.Key Words: Venous, Doppler, Sonography, Supine, Standing