Ultrasound has really revolutionised the way that doctors treat varicose veins and related
conditions.
We do not use just an ordinary ultrasound machine -- the machine that you might be familiar
with diagnosing gallstones or looking at pregnant mothers and their babies -- this is a special
sort of ultrasound called duplex.
Now what do I mean by "duplex"?
Well the ultrasound builds up a picture of the structures the blood vessels the veins
so that we can see it on the screen but then it also superimposes the flow of blood and
the direction so that we can tell where there are problems with veins.
Whether there are blockages whether there are problems with the valves and whether there
is flow in the wrong direction so-called "reflux".
So it is very important that we use a duplex ultrasound to diagnose vein problems.
Now I have got here a state-of-the-art ultrasound machine.
It is portable.
It wasn't just long ago it wasn't many years ago these ultrasound machines were in hospitals
on wheels and were moved around in elevator's and lifts.
But now we have got these portable ultrasound machines that look very much like a laptop.
And they do everything that we need now to look at veins and blood vessels.
Now I am going to show you the principles of duplex ultrasound on my arm.
To show you how it works.
Now the 1st thing we need to do is to use a water-based gel ultrasound gel.
Ultrasound very high-frequency sound waves do not travel in air.
So they need to be coupled onto the skin to then penetrate the tissues and bring back
a picture.
So whenever we are using an ultrasound probe we have got to put gel on it.
To allow the sound waves to come out of the probe and then into the tissues.
So having done that I can then put the ultrasound probe on my arm with a little bit of jelly
and then I can build up a picture on the screen of the blood vessels and the direction of
flow.
And I can do the same with legs - with the patient standing I can check the blood vessels
and check the direction of flow.
So let's see what some of the blood vessels in my arm look like.
So I have now got the blood vessel being demonstrated by the ultrasound it looks like a circle because
it is in transverse section as if we are going into a tunnel from my arm down towards my
hand.
One of the features that is characteristic of an artery is that when you press gently
with the probe it does not compress -- it is not squidgy.
So we can see the structures quite well with the B mode the greyscale ultrasound.
Now if I were to turn on the colour flow detector and look at that area we can see that we can
demonstrate our blood flow within that blood vessel.
And this is colour duplex ultrasound scan.
We can see the structures but we can also see the direction of flow and the movement
of blood within blood vessels.
So there's a brief explanation of how the duplex ultrasound works.
Now this scand that I am showing you is the junction of the main superficial vein with
the deep vein in the groin.
And you can see the delicate little folds in the lining which in this case are not meeting
properly and so when I squeeze the leg blood will go up which is the correct direction
but when I let go because the valves are not meeting properly blood comes down in the wrong
direction.
We call that reflux.
Now you can see the valves not meeting properly but you can also see that when I squeeze we
see that going up the leg and the equipment is configured such that blood flow going up
the leg looks blue on the colour duplex.
When I let go there should not be any colour because the valves should be shutting and
there should be no down flow of blood but in this case we can see that blood is coming
down in the wrong direction and it shows as a red signal.
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