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The imaging of the vasculature has advanced significantly in recent years and serves as an important tool to assess various types of venous diseases, from monochrome to four-dimensional color images, to the recent implementation of artificial intelligence.

In the early twentieth century, angiography was used to visualize the vascular system by injecting iodine into the bloodstream and viewing it with an X-ray. Ultrasound, CT, and MRI were later developed for more advanced vascular imaging techniques. Novel vascular imaging approaches lead to new discoveries in vascular pathology and more precise diagnosis.

Noninvasive diagnostic modalities have transformed the assessment of vascular diseases. Physicians can reach a diagnosis in a quick and effective way instead of invasive modalities. This chapter describes the current noninvasive diagnostic tools used in evaluating venous disease.


Obtaining a detailed history and thorough physical examination remains as the basis of venous disease diagnosis. Neglecting this crucial step will result in unnecessary testing and treatment. The onset, course, exacerbating/relieving factors, and related clinical signs and symptoms should all be defined in a thorough history. Recent surgical operations, extensive travel, immobility, history of cancer, trauma, drugs, and other disorders should all be also considered.

It’s imperative to determine whether a patient’s venous condition is acute or chronic. Early and prompt detection of acute venous illness has a substantial impact on disease progression and patient survival. Pain, swelling, and/or erythema are common symptoms. Upper extremity is less frequently involved with acute venous thrombosis. However, it could be encountered in the setting of venous thoracic outlet syndrome or Paget-Schroetter syndrome. Chronic venous disease, on the other hand, is caused by long-term abnormalities such as venous compression, venous anomaly, or venous insufficiency. The symptoms might range from minor varicose veins to nonhealing venous leg ulcers and incapacitating venous claudication.

Laterality of symptoms (unilateral or bilateral) has a major effect on differential diagnosis and evaluation modalities. In patients with unilateral symptoms, a localized venous cause or trauma is frequently the culprit. Meanwhile, in patients presenting with bilateral symptoms, a systemic condition “such as congestive heart failure, liver cirrhosis, or renal failure” should be suspected.

Risk factors for venous thromboembolism (VTE) should be carefully assessed during history-taking (Table 7-1). Prolonged immobility due to recent hospitalization, air travel, or long car trips increases the risk of deep vein thrombosis (DVT). Trauma is highly linked to DVT, whether to the lower limbs, chest, or abdomen. In addition, central venous catheters, pacemakers, and infusion ports are all linked to the development of DVT at the insertion site. A personal or family history of VTE or spontaneous abortion should raise suspicions of thrombophilia, whether inherited or acquired. DVT is increased by hormone replacement therapy, oral contraceptive pills (OCPs), and selective estrogen receptor modulators. Newer OCPs have a significantly lower amount of estrogen ...

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