Throughout each examination, the sonographer or examiner should:

• Observe sonographic characteristics of normal and abnormal tissues, structures, and blood flow, allowing 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

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

• Studies may be unilateral with the use of an appropriate algorithm. However, it is required to compare the common femoral spectral waveform from the contralateral limb, in this event.
• Transverse transducer compressions (when anatomically possible and not contraindicated) should be performed every 2 cm to ensure entire vein is assessed.
• Representative images are obtained per lab protocol.

Interrogation and documentation of compression of the following veins is the minimum requirement:

• Common femoral
• Saphenofemoral junction
• Proximal femoral
• Mid femoral
• Distal femoral
• Popliteal
• Posterior tibial
• Peroneal

The following veins are included if indicated or required by the facility specific-protocol:

• Inferior vena cava
• Common iliac
• External iliac
• Proximal deep femoral
• Great saphenous
• Small saphenous
• Gastrocnemius
• Soleal
• Anterior tibial
• Perforator

Spectral Doppler waveforms are required from the following veins:

• Right and left common femoral
• Femoral
• Popliteal

Additional waveforms are included if indicated or if required by the facility specific-protocol:

• Deep femoral
• Great saphenous
• Posterior tibial
• Peroneal

Spectral Doppler waveforms should accurately demonstrate the venous flow characteristics:

• Spontaneity
• Phasicity
• Flow augmentation with distal compression
• Pulsatility

• When pathology (thrombus or intraluminal echoes) is present:
• B-mode image should demonstrate the degree of compressibility to differentiate between partially or totally non-compressible segments
• Document the location, extent and echogenicity of thrombus
• Differentiate between unattached proximal thrombus (i.e., free-floating tails of thrombus) and attached thrombus
• Note dilatation/contraction of vein to assist in describing characteristics of aging the thrombus
• Include diameter measurements of any other abnormal structures (e.g., fluid collection, mass)