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Purpose: The advanced stage of chronic venous insufficiency (CVI) 4, 5, 6, which shown lipodennatosclerosis, venous ulcer might cause frustrating symptom compared with simple varicose vein. For successful treatment, precise anatomic, hemodynamic information of venous system is recommended. Although there is still controversy, duplex scan is the best way in evaluation of hemodynamic pathology. We studied key role of duplex scan in treatment of advanced CVI. Method: From November 1998, to February 2000, 125 patients were treated for CVI in our hospital. Of these 11 patients with class 4, 5, 6 were assessed by duplex scan, ascending venogram, hemodynamic functional studies. All venous segments were eagerly assessed for looking reflux. Except one patient who refuse surgery 10 patients received conventional surgical treatment and endoscopic perforator ligation. The one year follow up results were assessed. Result: 9 patients showed superficial venous reflux, 3 patients had deep venous reflux. In all 6 patients who had ulcer; incompetent perforator vein was identified. In 9 patients, stripping 8, high ligation 1, endoscopic perforator vein ligation 3 were done. During 1 year follow up clinical improvement was singificant in these 11 patients assessed with symptom scores. All ulcer were healed with average 25.3 days, and no recurrence. Conclusion: Although no single test was enough for perfect assessing CVI, scrupulous examination with duplex scan is best way for accomplishing successful outcome at presents.
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