Doppler examination vs clinical and phlebographic detection of the location of incompetent perforating veins: a prospective study.

Accuracy in excess of 80% has been claimed both for ultrasound and for phlebographic localization of incompetent perforating veins (ICPVs). To test these claims, a blind prospective study was carried out to compare three methods of simultaneous ICPV detection with operative findings. ICPV localization on the medial side of 39 legs was made by clinical examination, ultrasound, and ascending phlebography, each by a different observer. The ICPVs were confirmed at operation. All three methods were comparable in their accuracy in predicting the anatomical site of ICPVs. Phlebography produced fewer (seven) and ultrasound more (49) false-positive results than clinical examination did. There was no specific advantage of ultrasound over clinical examination. The advantages of phlebography, (1) fewer unnecessary explorations and (2) assessment of the status of the deep venous sytem, must be weighed against its cost and morbidity.