What imaging modality confirms venous insufficiency by showing stasis and/or occlusive disease?

• A. Venography
• B. CT angiography
• C. MRI of the brain
• D. Duplex ultrasound of the calves showing stasis and/or occlusive disease

Answer: (D)

Duplex ultrasound of the calves is the imaging test that confirms venous insufficiency by showing how blood is moving in the veins. It uses ultrasound to visualize the vein structures and Doppler to measure flow. This combination lets you see slow or stagnant flow (stasis), which points to venous insufficiency, and it can also detect occlusion from clots or narrowing of veins. Importantly, it can demonstrate valvular reflux by showing retrograde flow when the vein is stressed with maneuvers, which is a hallmark of venous incompetence. Because it’s noninvasive, widely available, and provides both anatomic and dynamic physiologic information, it’s the best choice for confirming venous insufficiency. Venography is invasive and mainly used for planning procedures; CT angiography shows anatomy and acute clots but doesn’t assess reflux as effectively; MRI of the brain isn’t relevant to leg venous disease.