From Diagnostic Variability to Clinical Precision: Development of a Comprehensive Evidence-Based Ultrasound Guideline for Chronic Venous Insufficiency to Promote Best Practices by Incorporating a Professional Survey, Guideline Analysis, and Anatomical Expansion

Abstract

Chronic venous disease (CVD) is a prevalent condition that significantly affects patients’ quality of life. Recurrence after varicose vein treatment has been reported to reach up to 80%, despite recent advances in minimally invasive endovenous techniques. Duplex ultrasound (DUS) remains the gold standard for diagnosing CVD, and performing high-quality examinations is of paramount for improving treatment outcomes and reducing early recurrence.

This thesis offers a comprehensive evaluation of CVD using DUS. It begins with an exploratory survey that reveals inconsistencies in the performance and reporting of DUS examinations among Australasian sonographers, identifying knowledge gaps and highlighting areas requiring improvement to achieve standardised practice. A critical appraisal of existing guidelines uncovers the root causes of these variations and lays the foundation for developing a methodologically rigour and practicable guideline. Subsequent empirical research expands the understanding of lymph node venous networks, anatomical variations at junctions, and non-saphenous reflux as these entities are often poorly recognised or under-diagnosed yet carry significant clinical implications for therapeutic management of CVD.

Finally, through a major collaborative project led by the author with expert sonographers, phlebologists, and professional association, this thesis presents a new comprehensive ultrasound guideline grounded in the best available evidence. The new guideline combines explanatory and educational content, offering general and specific recommendations aimed at enhancing diagnostic quality and promoting widespread adoption in clinical practice.