Can preoperative duplex marking of the saphenopopliteal junction be avoided?

Abstract

Objectives: Patients undergoing saphenopopliteal junction (SPJ) surgery are currently subjected to two duplex scans. The first is to confirm the reflux, and the second is done preoperatively to accurately mark the SPJ for surgery. The aim of this study was to assess whether the use of hand-held Doppler (HHD) can substitute the second duplex scan. Methods: Sixty limbs with suspected SPJ reflux were studied. Patients underwent an initial duplex scan. The report detailed the position of SPJ in relation to popliteal crease. Guided by this, a HHD was then used to mark the SPJ. Deviation of the HHD mark from the duplex one of ≤10 mm was considered acceptable for surgical accuracy. Results: HHD accurately localized all 27 patients with SPJ reflux (100% accuracy). The distances between the HHD and duplex points in this group ranged between 0 and 5 mm (median=0). Twenty-five patients had SPJ with no reflux, and 22 of them were accurately localized (88%). The distances between the two points in the latter group ranged between 0 and 16 mm (median=3). Conclusion: HHD, guided by the routine duplex scan, can accurately mark SPJ with reflux. A second duplex is not required for marking prior to surgery. This will reduce the workload of the vascular laboratory.