Clinical Protocol

Venous Insufficiency Imaging: A Complete Duplex Protocol for CVI Assessment

The gold standard diagnostic exam for CVI maps the entire venous system with reflux durations, diameters, and CEAP documentation.

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Chronic venous insufficiency (CVI) affects an estimated 40% of US adults. A comprehensive duplex exam is the gold standard for diagnosis, severity assessment, and treatment planning.

CEAP Classification Context

Clinical class ranges from C0 (no visible disease) to C6 (active ulceration). Most insurance carriers require C2 or higher plus documented reflux for treatment authorization. Build required fields into your report template.

Complete Exam Sequence

Start with the deep system: CFV, femoral vein, popliteal vein, and tibial veins. Assess compressibility (rule out DVT) and reflux. Move to the superficial system: SFJ, full GSV, SPJ, SSV, AASV, and tributaries. Finish with perforators: medial calf and thigh for incompetent perforators.

Workflow Optimization by Machine
  • MX7/M8 Elite: Use iWorks to create a standardized CVI protocol.
  • Resona i9T: V Flow at junctions provides hemodynamic assessment without manual angle correction.
  • Consona N9: Built-in vascular measurement package with structured report templates.

Documentation for Insurance Authorization

Required fields: reflux duration exceeding 0.5 seconds in the target vein, CEAP clinical class, symptoms, and failed conservative therapy (compression 3-6 months).

Frequently Asked Questions
What is venous insufficiency imaging?
A duplex ultrasound exam evaluating the venous system for valve incompetence, obstruction, and anatomical variants using B-mode and Doppler.
How long does a CVI exam take?
30-60 minutes for a complete bilateral exam. iWorks protocols can reduce time by 15-20%.
What CEAP class requires a full duplex?
C2 (varicose veins) or higher.
Does Mindray have a CVI preset?
Yes. Mindray ships with Lower Ext Vein presets. Capital Health configures these during setup.