Varicose Veins: Diagnosis and Investigations by Sohail Choksy

Varicose veins: Diagnosis and Investigations

In the leg there are two sets of veins, supeficial veins near the skin and deeper veins within the muscle. Varicose veins affect the superficial veins in the leg causing them to become dilated and tortuous. They are visible as lumpy swellings beneath the skin with a bluish dis-colouration (varicosities). The varicosites that you can see are usually filled by vein trunks commonly the long saphenous or short saphenous vein whose valves are defective, causing blood to pool in them. Symptoms attributable to varicose veins are due to increased pressure in the veins (venous hypertension). Veins are most prominent and symptomatic when standing due to gravity. A common aim of all treatment is removing, blocking off or interrupting the long or short saphenous veins.

Symptoms of varicose veins

Varicose veins commonly cause the following symptoms: Acheing Throbbing Tenderness Cramps Leg heaviness Itching Swelling Can be unsightly

In some cases varicose veins can cause complications which include:

Skin discolouration (brown) Thrombophlebitis Skin eczema Bleeding and ulceration

What causes them?

Varicose veins are often inherited (genetic). They are made worse by prolonged standing, pregnancy and obesity.

Normally one way valves keep blood flowing upwards in the veins towards the heart. If these valves don't function properly blood can pool in the veins causing them to bulge.

This can lead to "venous hypertension" which is responsible for most of the symptoms and complications attributable to varicose veins. Click here for ananimation on varicose veins. Investigation of varicose veins

Investigation begins with a thorough clinical assessment of symptoms and signs.

The hand held doppler (similar to that used to listen to the babies heart during pregnancy) is used to establish the sites of leaky valves ("reflux") between deep and superficial veins. At these site blood flows the wrong way giving rise to varicose veins further down the leg. The commonest sites of leaky valves are in the groin (the saphenofemoral junction), behind the knee (the saphenopopliteal junction) and in the midthigh/calf (perforators).

Modern treatment of varicose veins relies on the use of a colour duplex ultrasound machine to create a "road map" of leaky veins in the leg. Information from the scan can also help the surgeon decide which type of treatment is most suitable for the patient.