Ultrasound Evaluation of Deep Lower Vein Extremities

Venous Ultrasonography (DVT) is the most common imaging diagnostic for people having acute deep venous thrombosis.

In October 2016, the Society of Radiologists specified a multidisciplinary panel of experts to create recommendations on DVT ultrasound protocols and the language used to report its results.

The panel advised against compression-only exams and favored a particular duplex ultrasound technique from the thigh to the ankle. These suggestions will improve calf DVT diagnosis and offer better information to explain the symptoms. The panel advised a single point-of-care protocol to reduce proximal DVT underdiagnosis.

Patient selection:

Several guidelines suggest using clinical prediction rules to calculate the pretest probability of DVT before ordering an ultrasound. Among the available tools, the Wells score is the clinical decision rule most frequently used for risk stratification.

Clinical Model for Predicting Deep Venous Thrombosis Pretest Probability:

Clinical characteristics:


Current cancer (patient undergoing palliative care or receiving cancer treatment now or within the past six months)        1
Lower extremity paresis, paralysis, or recent plaster immobilization        1
Recent major surgery requiring general or regional anesthesia or current bed rest of three days within the previous 12 weeks        1
Localized tenderness along the deep venous system’s distribution        1
The whole leg is swollen        1
Calf swelling is more significant than the unaffected side by at least 3 cm (measured 10 cm below the tibial tuberosity)        1
Pitting edema (limited to the affected leg)        1
Superficial collateral veins (non-varicose)        1
History of deep vein thrombosis        1
Deep venous thrombosis       -2
If you receive a score of ≥ 2, it means that deep vein thrombosis is likely to occur; if you receive a score of <2, it is unlikely to happen. The more painful leg is used when a patient has pain in both legs.


Patients who receive an ultrasound should have a D-dimer test if they have a likely pretest probability of DVT, an unlikely pretest probability of DVT, or if the pretest probability was not determined.

Vascular Ultrasound:

Vascular ultrasound uses sound waves to assess;

  • Body’s circulatory system
  • Find artery
  • Vein blockages
  • Find blood clots

This examination frequently includes a Doppler ultrasonography study to assess blood flow through a blood vessel. In addition, ultrasound can produce images of invisible soft tissues on x-rays. For this surgery, little to no prior preparation is needed. Avoid wearing jewelry and dress comfortably in loose-fitting clothing.

Typical Uses of the Procedure:

The body’s circulatory system can be assessed using sonography. Additionally, vascular ultrasound is used to;

  • Aid in keeping track of the body’s organs and tissues’ blood flow.
  • Locate and identify abnormalities like plaque or emboli and blockages (stenosis), and assist in planning their effective treatment.
  • Find deep venous thrombosis (DVT) in the central veins of the arms or legs.
  • Ascertain a patient’s suitability for a procedure like angioplasty.
  • Determine the effectiveness of techniques.
  • Find out the enlargement of any artery.
  • Check for varicose veins.

More specifically, ultrasound is used for children to;

  • Reduce the chance of complications, including bleeding, nerve injury, or a pseudo-aneurysm, by inserting a needle or catheter into a vein or artery.
  • Analyze a connection between an artery and a vein, such as those found in dialysis fistulas and congenital vascular malformations (also known as arteriovenous malformations or fistulas).

Doppler ultrasound aids in the physician’s observation and assessment of;

  • Obstructed blood flow (such as clots).
  • Vessel narrowing.
  • Cancers and vascular abnormalities (developed earlier).
  • Reduced or nonexistent blood supply to various organs, including the ovary and testes.
  • Increased blood flow: a sign of infection.


  • https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.030687
  • https://www.radiologyinfo.org/en/info/vascularus