Objective: To investigate the feasibility and efficacy of assessing the calf perforating veins using the ankle pump method in a sitting position by color Doppler ultrasonography.
Methods: We performed a multicenter prospective clinical trial between November 2022 and October 2023. Eligible patients with chronic venous disease and healthy controls were enrolled. The calf perforating veins were assessed by three different methods, namely manual compression in a standing position, manual compression in a sitting position, and ankle pump in a sitting position. The reflux durations and detection rate of the incompetent perforating veins were compared among the three methods. The number and diameter of calf perforating veins and the distribution of incompetent perforating veins were analyzed.
Results: A total of 50 patients with chronic venous disease and 50 healthy controls were included. There were 173 calves analyzed, including 97 healthy calves and 76 calves with chronic venous disease. The median number of perforating veins per calf was higher in the diseased calves (7.0, interquartile range 6.0-8.0) than the healthy calves (5.0, 3.0-6.0) (p < 0.001). The diameter of incompetent perforating veins (2.3, 2.0-3.1 mm) was larger than that of competent ones (1.4, 1.2-1.7 mm). Most of the incompetent perforating veins (78.8%) were located in the medial and posterior middle of the calf. The reflux duration induced by the ankle pump method was greater than that induced by the manual compression methods (p < 0.001). Although the ankle pump method had a higher detection rate (92.0%) of incompetent perforating veins than the manual compression methods (71.7% and 74.3% for standing and sitting positions, respectively) (p < 0.001), especially in the distal lower leg, the manual compression methods revealed the incompetent perforating veins that were not shown by the ankle pump method.
Conclusions: The diseased calves with chronic venous disease have more perforating veins than the healthy calves. Incompetent calf perforating veins are commonly larger than competent perforating veins, with the majority of the incompetent calf perforating veins being located in the medial and the posterior middle of the calf. Most importantly, the AP-sit method provides a convenient and effective approach for assessing the calf perforating veins, especially those located in the distal calf, as an alternative or complementary to traditional manual compression, which is valuable in the daily practice of sonographers.
Keywords: Ankle pump; Chronic venous disease; Color Doppler ultrasonography; Perforating veins of the calf; Sitting position.
Copyright © 2024. Published by Elsevier Inc.