Duplex Ultrasound Diagnosis in Varicose Veins

Duplex ultrasound (DUS) is the primary imaging modality for diagnosing chronic venous disease, including varicose veins, because it provides simultaneous hemodynamic and anatomical information.Recent clinical practice guidelines from the European Society for Vascular Surgery and the guidelines of the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society have defined standardized DUS techniques, reflux criteria, mandatory venous segments for evaluation, and structured reporting for patients with varicose veins.The Korean Society for Phlebology recently developed evidence-based ultrasonography guidelines and a national standard protocol tailored to local practice environments.This narrative review integrates the key recommendations from international and Korean guidelines and summarizes a stepwise, standardized DUS protocol for lower-extremity varicose veins, including patient preparation, examination in gravity-dependent positions, reflux-provoking maneuvers, and segment-by-segment assessment of superficial, perforating, and deep veins.Vascular laboratories can improve the diagnostic accuracy, interobserver agreement, and treatment planning for patients with chronic venous disease in routine clinical practice by adhering to harmonized guideline-based protocols and uniform reporting standards.