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December 10, 2019

AVLS Issues Recommendations on Ultrasound Testing for Venous Insufficiency of Lower Extremities

December 10, 2019—The American Vein & Lymphatic Society (AVLS) issued a statement on behalf of the AVLS Ultrasound Section advising that all testing for venous insufficiency of the lower extremities should be done in the standing position, unless constrained by physical limitations of the patient. This scanning method produces better studies and promotes an ergonomically welcoming workplace, the society emphasized.

According to the AVLS, research supports the standing position versus supine or reverse Trendelenburg positions during duplex scanning for the detection of venous reflux. Studies have shown that supine or reverse Trendelenburg positions may result in false positive or negative readings. The standing position provides accurate, detailed information about the pathophysiology of reflux in the lower extremity veins by allowing the entire circumference of the lower extremity to be investigated. Conversely, the supine or reverse Trendelenburg positions limit visualization of the lateral and posterior lower extremity.

Additionally, the AVLS advised that although the standing examination is the most reliable and accurate way to perform this examination, it can be challenging for the sonographer and bring about ergonomic strain. The proper equipment, along with sound protocols, protects sonographers and medical staff from unnecessary work-related injuries.

The statement noted that a Society of Diagnostic Medical Sonography white paper in 2018 reported that an estimated 90% of clinical sonographers experience symptoms of work-related musculoskeletal injuries.

The following equipment is recommended by the society to provide accurate venous insufficiency examinations while preventing workplace injuries: a rapid cuff inflator; height-adjustable stool; height-adjustable ultrasound equipment; and a standing platform. With these tools, sonographers will be able to set up a comfortable examination room, helping them to avoid workplace injuries and their associated costs. This will also allow sonographers to obtain accurate, reproducible venous reflux examinations that deliver better treatment plan options, stated the AVLS.

The full statement from the AVLS Ultrasound Section is available online here.

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