Changes: The Latest Revisions To The ICAVL Standards [continued]

Peripheral Venous Testing (continued)

A better defined process for testing for obstruction (DVT) is now provided:

3.2.1.1 Testing for DVT or obstruction: A unique protocol must be defined for the examination to evaluate for DVT or venous obstruction. Documentation of areas of suspected thrombosis must include additional representative images.

Related to representative transverse gray scale images and the minimum lower extremity images required, saphenofemoral junction and proximal femoral vein were added for clarification. Significantly, posterior tibial veins and peroneal veins now appear as part of this list as the Board of Directors has determined that there is sufficient published evidence warranting the inclusion of calf vein imaging:

• Common femoral vein
• Saphenofemoral junction
• Proximal femoral vein
• Mid femoral vein
• Distal femoral vein
• Popliteal vein
• Posterior tibial veins
• Peroneal veins

3.2.1.2 Testing for lower extremity reflux

3.2.1.2.1 Imaging (for assessing venous patency): Representative gray scale images with and without transverse transducer compressions (when anatomically possible or not contraindicated) must be documented as required by the protocol and must include at a minimum images of:

• Common femoral vein
• Saphenofemoral junction
• Mid femoral vein
• Great saphenous vein
• Popliteal vein
• Small saphenous vein
• When appropriate or as required by the laboratory's written protocol: common and external iliac veins, inferior vena cava, proximal deep femoral vein, deep calf veins, and perforating veins.
• When appropriate or required by the laboratory's written protocol, measurements must be recorded.

3.2.1.2.2 Doppler (for assessing venous reflux): The protocol should describe how color-coded Doppler is utilized to supplement gray scale imaging and spectral Doppler. Documentation of areas of suspected reflux must include spectral Doppler. Representative spectral Doppler waveforms and/or color Doppler must be documented at baseline and during reflux producing maneuvers as required by the protocol and include at a minimum the following vessels:

• Common femoral vein
• Saphenofemoral junction
• Great saphenous vein
• Femoral vein
• Popliteal vein
• Small saphenous vein
• When appropriate or as required by the laboratory's written protocol: common and external iliac veins, inferior vena cava, proximal deep femoral vein, deep calf veins, perforating veins, and other accessory venous tributaries.

3.2.1.2.3 If plethysmography is used, a written protocol must be in place that defines its components, including its use in conjunction with duplex scanning:

• Plethysmographic tracings showing baseline and response to appropriate maneuvers must be documented.

3.2.1.3 Vein mapping: Representative transverse gray scale images must be documented according to the laboratory's written protocol. Areas of abnormality should be documented with additional images.

3.2.1.3.1 The veins of interest should be assessed for size and patency.

3.2.1.4 Other venous testing (e.g., assessment of the calf muscle pump)

3.2.1.4.1 If other venous testing is done, a written protocol must be in place that defines its components.

• Representative gray scale images must be documented as required by the protocol
• Representative spectral Doppler waveforms must be documented as required by the protocol
• Any other venous testing component used (e.g., color Doppler or plethysmography) must be documented as required by the protocol

Related to diagnostic criteria the following changes have occurred:

4.1.2 When assessing for obstruction, there must be criteria for interpretation of imaging, transverse compression, and Doppler waveforms.

4.1.3 When assessing for reflux, there must be criteria for interpretation of venous reflux and valve function.

4.1.4 When mapping veins, there must be criteria for interpretation of vein size, patency, compressibility and course.

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