Varicose Veins/Lower Extremities, Venous Insufficiency, Duplex Ultrasound


  • Obvious bulging, twisted veins below the skin, requiring treatment
  • Appearance of spider veins (telangiectasia) in the affected leg, with or without pain, to rule out underlying superficial venous incompetence
  • Swelling in the feet and ankles
  • A feeling of heaviness, tiredness, and aching, at the end of the day or after periods of prolonged standing, or, for women at varying times throughout the menstrual cycle.
  • Persistent itching of the skin, in the lower limb
  • Dermatitis in the lower limb
  • Changes in skin colour over the affected area, bottle neck appearance in the distal, lower leg/ankle
  • Ulcerative changes in the distal, lower limb and/or feet
  • Palpable, painful, red lump in the lower limb, to rule out superficial venous thrombosis
  • Surveillance pre-operative and post-operative

Contraindications and limitations:

  • Extreme leg girth (obesity, excessive musculature, or extreme oedema)
  • Site trauma such as open wounds/colostomy, in the scanning area
  • Casts or dressings that cannot be removed
  • Patients that cannot be adequately positioned

Patient preparation:

  • Eat breakfast, lunch or a snack within 3 hours prior to attending the ultrasound appointment.
  • Be well hydrated. Please ensure 500ml-1500ml of water has been consumed prior to the ultrasound, unless there is an underlying medical condition, that requires fluid restrictions. Please note: Coffee, tea and alcoholic drinks are dehydrating; these drinks are not included in the 500-1500mls of water. WHY? Being hydrated increases the blood volumes which allows for improved visualisation of the veins plus, low blood sugar levels and dehydration can be associated with a vasovagal response (light headiness, or fainting), whilst standing. Nutrition and hydration can help reduce the risk of this occurring.
  • On the day of the test, refrain from applying oils or moisturisers to the lower limb


What to wear:

Loose-fitting clothes, for example; elasticated skirt/pants/shorts.

Ultrasound study technique:

Ultrasound is a non-invasive diagnostic study. The patient will stand on the floor, or, if tolerated, on an elevated platform, with the leg being examined, externally rotated. Ultrasound gel will be applied to the leg. An ultrasound probe will be run over the leg from the groin to the ankle. The ultrasonographer will manually squeeze the leg, multiple times, to segmentally assess the valvular function of the deep and superficial veins. Most people tolerate the squeezing quite well, however, this can create mild discomfort. Our Ultrasonographer’s will do their best to be as gentle as possible, and to avoid squeezing painful areas. If distal augmentation is not tolerated, other techniques can be used, for example, Valsalva manoeuvre, for the veins in the groin, and toe/ankle flexion and extension, for the leg veins. Very occasionally people may experience mild pain and/or bruising, following the ultrasound; this is not common however, if these symptoms occur, we would appreciate patients informing us. Images will be obtained, and the results documented on a worksheet.

NOTE: During the examination of the common femoral vein, in the groin, if there is ultrasound evidence or suspicion, of a more proximal thrombus, for example; thickened vein wall, the presence of occlusive or non-occlusive thrombus, or the loss of normal phasic, venous blood flow, the ultrasonographer may extend the ultrasound to the abdominal veins and inferior vena cava (IVC).

Ultrasound study time:

  • 20-30 minutes per leg.
  • Plus, an additional 20-30 minutes, if the assessment of the abdominal veins, is required (see note above)


A worksheet can be available, if requested. A formal written report will be available within 24 to 48 hours, following the ultrasound examination, Monday to Friday. If the ultrasound findings demonstrate pathology, which may require urgent attention, the referring Doctor will be notified ASAP following the completion of the ultrasound.