Duplex scanning may be used selectively in patients with primary varicose veins.

Reflux was assessed using hand-held Doppler (HHD) and duplex scanning in 72 patients with primary, previously untreated varicose veins (108 limbs). The aims of the study were (i) to compare the accuracy of HHD assessment with duplex scanning, (ii) to assess the benefit of tourniquet testing and (iii) to identify patients who would benefit from a policy of selective duplex scanning. HHD accurately assesses the saphenofemoral junction (SFJ) and long saphenous vein (LSV) reflux. HHD assessment of the saphenopopliteal junction (SPJ) reflux has a low positive predictive value. A high negative predictive value reflects absent SPJ reflux assessed using HHD accurately. Tourniquet testing is not helpful. Selective duplex scanning of limbs with suspected SPJ reflux, no identifiable site of reflux or posterior thigh perforator reflux on HDD (39% of limbs), would result in the appropriate surgical procedure being performed in 102 (94%) limbs, excessive surgery in 5 (5%) limbs and inadequate surgery in only 1 (1%) limb. The use of selective criteria for duplex scanning would reduce the workload of the vascular laboratory without compromising patient care.