Management of Disease Found by an Ultrasound
Duplex ultrasonography (combined B-mode and Doppler) has replaced catheter-based contrast venography. When chronic venous disease is diagnosed, its management and treatment can be followed via ultrasound as interval evaluations for efficacy of treatment.
Advanced Venous Disease
Advanced venous disease includes edema, skin changes, and ulcerations. If initial conservative medical management fails (compression, elevation, ulcer care), more aggressive treatments can be implemented, such as endovenous interventions:
- Ablating (destroying) venous areas of insufficiency (reflux)
- Removing veins or ablation. Such interventions reduce the amount of blood in the venous circulation of a limb, thereby lessening the venous hypertension in the tissues
- Surgical control of bleeding varicose veins, followed by ultrasound to identify any remaining venous reflux
- Management of recurrent vein thrombosis
- Venous stenting or reconstruction, to recanalize previously obstructed veins
The destruction of veins can be done in two ways:
- Surgical excision: This is the mechanical removal of problematic veins.
- Sclerotherapy: Ablation is via chemical or thermal destruction.
Medical Management of Thrombotic Disease
Anticoagulation is the preferred treatment for deep vein thrombosis (DVT), as soon as possible, since the longer the clot remains, the more likely it will break off and migrate as an embolus. The duration of treatment is individualized, but is usually prolonged, at least three months.
Follow-up is via serial ultrasound surveillance for clot resolution and to rule out clot extension.
Other Treatment Using Ultrasound
- Tendinopathy: Ultrasound can generate a deep heat in inflamed tissues, which stimulates blood flow that hastens healing and delivers anti-inflammatory cytokines to the inflamed areas. Ultrasound is used to deliver this therapy in cases of tendinitis and muscle strain from overexertion or repetitive strain injuries. Some patients have found it helpful while others have not seen improvement. The advantage of ultrasound, in spite of its varying results on a patient-by-patient basis, is that there is no disadvantage to use it, nor any complications from it, so it is often included in strategies for a combined approach to tendonitis and myositis.