DIAGNOSTIC NOTES PHYSICIAN

Diagnostic workup is noninvasive; physical examination with color flow duplex ultrasound imaging is adequate in the majority of patients presenting with lower-extremity venous disease. One should be familiar with the anatomy of the GSV, anterior accessory saphenous vein, posterior accessory saphenous vein, thigh circumflex veins, SSV, vein of Giacomini, perforating veins of the thigh and calf, and the deep venous system. The GSV and SSV are identified sonographically in their respective saphenous canals. If incompetent by duplex imaging, they may be sources of venous hypertension and are candidates for endovenous ablation. Vein diameters, obtained via duplex ultrasound imaging with the patient in the standing position, must be documented to guide energy delivery.