Ultrasound guidance for endovenous treatment

Duplex ultrasound provides physicians with practical information about venous anatomy and physiology. It is the established method to assess superficial, deep, and perforator veins of the lower extremity for competence, acute thrombotic conditions, and postthrombotic changes. In addition, the use of duplex ultrasound has become an integral part of endovascular treatment, as it provides guidance for venous access and administration of tumescent anesthesia. It allows peri- and intraprocedural monitoring of venous treatments as well as postprocedural assessment of technical success and of thrombotic events or other complications after the procedure. This chapter will provide valuable details for the use of duplex ultrasound for preprocedure planning, venous access, periprocedural monitoring, and postprocedural evaluation. In the venous ulcer patient specifically, ultrasound guidance is vital for saphenous and perforator vein ablation, as well as the treatment of varicose vein tributaries leading to and beneath the ulcer bed.