CLINICAL EXAMINATION LOST ART IN MEDICINE? : DIAGNOSTIC ROLE OF VENOUS COLLATERALS IN DETERMINING PROXIMAL VENOUS OBSTRUCTION.

Introduction: In this era of advanced medicine, the role of basic clinical examination is a forgotten art. Aim of the study is to determine the diagnostic role of visible venous collaterals determined by clinical examination in diagnosis of proximal venous obstruction. Material and Methods: This is an observational study done in 30 patients with venous leg ulcers in the past two years (2015-16). These patients were thoroughly examined clinically for visible venous collaterals. Confirmation of proximal venous obstruction is by means of CT or Conventional Venogram. Results: Out of 30 patients, 9 were found to have visible venous collaterals on clinical examination. 17 patients were confirmed to have proximal venous obstruction. All of these nine patients with venous collaterals found to have proximal venous obstruction. In our study, specificity and positive predictive value of the clinically visible venous collateral vein were found to be 100% each.With sensitivity and negative predictive values 52.94% and 61.9% respectively. Conclusion: Thus clinically visible venous collaterals in patients with venous leg ulcers are highly specific in diagnosing proximal venous obstruction. Emphasizing the fact that even in this era of advanced diagnostic modalities, basic clinical examination skills still holds good.