**3. Diagnosis**

Although simple at first glance, the diagnosis of venous disorders is essentially difficult due to specific hemodynamic conditions in the venous bloodstream.

A well-taken anamnesis can greatly help us in making an adequate diagnosis, and just the taking of anamnesis is considered to be a special skill, but for now there are no adequately conducted studies on the value of specific items for anamnesis. It is necessary to take data related to [18]: major symptoms exhibited and experienced, previous medical history, varicosity and treatment of varices, superficial and deep venous thrombosis, leg ulcer, peripheral arterial vascular disorder, diabetes mellitus, rheumatoid arthritis, extensive leg trauma, nutritional status, patient mobility, family anamnesis and specific leg ulcer aspects (duration, pain, previous treatment, symptoms of ulcer infection, the ankle joint mobility).

Today, the following diagnostic procedures are used to examine the venous system: Color-flow duplex ultrasound in the diagnosis of vascular diseases is widespread today, both because of its high sensitivity and accuracy, and the fact that it is a simple and safe diagnostic procedure. This method measures the diameter of the blood vessel, the duration of reflux, the presence of flow and the compressibility of the vein. The examination is performed in a standing position [19]. When examining the deep venous system up to the inferior vena cave, the patient is placed in a supine position [20]. The duration of reflux in normal proximal veins of the legs is <1 s while in distal veins <0.5 s.

Direct venous pressure measurement is an invasive diagnostic method where venous pressure is directly measured using a cannula in the superficial vein of the foot [21]. It was found that there is a direct correlation between the height of the pressure in the vein of the foot and the height of the pressure in the deep veins at the height of the ankle. Direct measurement of venous pressure is rarely used today because it is an invasive diagnostic technique and is not recommended as a routine diagnostic method in patients with venous ulcers.

Ankle-brachial pressure index (ABPI) is used to evaluate adequate arterial blood flow. A large number of studies have shown that about 30% of patients with VLUs also have a disease of the peripheral arterial system. Ulcers that occur in these patients may be due to diseases of the peripheral arterial system or occur in combination with venous insufficiency. Normal ABPI values range from 0.91–1.20. If ABPI is >0.8 arterial abnormality on the arteriogram is generally ruled out (chance >95%) [22].

Plethysmography, phlebodynamometry and phlebography, are less used methods due to inferior accuracy and associated risks [23, 24].

Application of bacteriological examination or biopsy of ulceration and pathohistological examination will be applied in case of suspicion of infection or malignant etiology of ulceration.
