Throughout each examination, the technologist/sonographer/examiner should:

• Observe the sonographic characteristics of the normal and abnormal tissues, structures, and blood flow to allow necessary adjustments to optimize exam quality
• Assess and monitor the patient’s physical and mental status, allowing modifications to the procedure plan according to the patient’s clinical status
• Analyze sonographic findings to ensure that sufficient data is provided to the physician to direct patient management and render a final diagnosis

Sonographers should follow a standard imaging protocol per facility-specific anatomic algorithm. A complete venous duplex evaluation incorporates B-mode and spectral Doppler with color and/or power Doppler imaging

Transverse grayscale images with and without transducer compressions must include evaluation of the superficial vein to be used for bypass conduit, and a deep vein evaluation, these include the:

• Common femoral veins
• Saphenofemoral junction
• Mid femoral vein
• Popliteal vein
• Tibial and peroneal veins (if indicated)
• Great saphenous vein (GSV)
• Small saphenous vein (SSV)
• Abnormalities require additional images when present
  • The location, severity and characteristics of thrombus should be documented in transverse and longitudinal planes
• If requested, map the course of the vein(s) using indelible marker

Diameter measurements are indicated by the planned procedure type, but typically include transverse measurements of the:

• GSV in proximal, mid and distal thigh/knee; proximal, mid and distal calf
• SSV in proximal, mid and distal calf (when needed/requested)
• Femoral vein in proximal, mid and distal thigh (when needed/requested)

Spectral Doppler waveforms for assessing venous patency of the lower extremity and showing variations with respiration and/or flow augmentation should include the:

• Common femoral veins
• Popliteal vein
• Additional sites may be necessary when indicated by the planned procedure type:
  • Lower extremity dialysis access mapping requires a limited evaluation and diameter measurements of the common femoral and superficial femoral arteries
• Venous Doppler waveforms are characterized according to:
  • Spontaneity
  • Phasicity
  • Augmented venous flow with proximal or distal augmentation
  • Pulsatility