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WHEN TO PERFORM A DOPPLER EXAMINATION

When there is a need to supplement the physical examination, continuous wave Doppler (CWD) was the test modality most often available to the clinician until compact, affordable Duplex units became readily available. The CWD examination was considered as an essential part of every physical examination of the venous system and the handheld Doppler was considered to be the “stethoscope” of the phlebologist. Although largely replaced by Duplex ultrasound, a basic understanding of use of the stethoscope of phlebology is still important.

Continuous wave Doppler or Duplex ultrasound can provide essential information in many clinical presentations: when a patient complains of pain related to varicosities, when the physical examination reveals varicosities larger than 3 mm in diameter, when varicosities of any size extend into the groin or the popliteal fossa, and when a feeding vessel is sought for a focal area of grouped venulectases (1–2 mm).1 Guidelines for the use of this diagnostic aid to physical examination are listed in Table 8-1. Doppler examination may suggest the need for additional testing but is especially helpful as an inexpensive screening tool if a duplex ultrasound examination is not available as is currently the case in many developing nations.

TABLE 8-1Guidelines for the use of Doppler

The purposes of the CWD examination are multiple: to identify or rule out reflux at the saphenofemoral and saphenopopliteal junctions, to trace the course of varicosities, and to identify other points of reflux through incompetent perforating veins in the thigh, calf, and ankle (Table 8-2). CWD also gives an approximate sense of the speed and phasicity of venous flow at the saphenofemoral junction.

TABLE 8-2Purpose of CWD Doppler Examination (mainly replaced by Duplex ultrasound)

Many physicians are familiar with the rapid, pulsatile sound of ...

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