Diagnostic procedures for venous problems

Summary Venous diseases are a common worldwide problem. Numerous methods for the evaluation of the venous system are available. The major objectives include the diagnosis and medically relevant classification of varicose vein disease, as well as the identification and assessment of hemodynamic disturbances. In addition, it is necessary to characterize and classify disturbances of the deep venous system and to differentiate between primary and secondary varicose veins. The physician should also exclude or detect and classify concomitant peripheral arterial occlusive disease, and an accompanying disorder of lymphatic drainage. The diagnostic evaluation of venous disorders, depending on the severity of the disease, includes as standard the use of Doppler sonography. Light reflection rheography (LRR), photoplethysmography (PPG), venous occlusion plethysmography and phlebodynamometry (PD) complete the hemodynamic evaluation. The standard imaging technique now routinely used is duplex color scanning. More complex imaging studies include ascending and descending phlebography computed tomography or magnetic resonance imaging. In selected cases invasive investigations or serological tests may complement the diagnostic work‐up.