DIAGNOSTIC TOOLS FOR THE EVALUATION OF VARICOSE VEINS

 

The most valuable method in the diagnosis of varicose veins is a "well performed" color Doppler ultrasound examination. However, listening to and evaluating patient complaints, history, background, and performing a simple clinical examination can also provide valuable information.

 

Most varicose veins cause signs of venous insufficiency such as pain, burning, itching, cramping and swelling. However, these complaints are not specific to varicose veins, and may occur in other diseases involving the legs, sometimes even in normal persons. For example, leg pain may be a sign of rheumatic diseases, meniscus, arthrosis, bone resorption, heel spur, discal hernia and arterial obstruction. Likewise, swelling of the legs may be due to heart failure, renal failure, venous occlusion, inactivity and some medications. Occasionally, both the varicose veins and one or more of these diseases may coexist in the same patient and the situation may be more confusing. Even in such cases, however, it may be decided to what extent the patients complaints such as pain and swelling are caused by varicose veins.

 

In addition, a lot of valuable information may be obtained from the patient such as weight, age, sex, profession, lifestyle, pregnancy, clotting, bleeding, venous ulcer and cosmetic concerns, and this information may change the diagnosis and management.

 

Varicose veins should be carefully examined after taking the patient's history. In some patients, the location of varices may give an idea of ​​the type of underlying venous insufficiency. For example, in great saphenous vein insufficiency varices are usually located in the inner calf, in small saphenous vein insufficiency in the posterior-outer part of the calf and in pelvic vein insufficiency in the inner part of the groin and genital region. In patients with capillary varices, the presence of spider veins with greenish reticular varices on the outer side of the leg strongly suggests lateral subdermic plexus (LSVP) varices. Open or closed wounds due to venous insufficiency may be seen on the inner or outer surface of the ankle and this is a symptom of late stage varicose disease. Again, around the ankle, capillary varices similar to blackberry called "corona phlebectica" may be seen, and most of these patients have an underlying serious venous insufficiency.

 

 

 

 

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Sudden clotting of varicose veins can be seen in a significant number of patients with varicose veins. This condition, called superficial vein thrombosis or superficial thrombophlebitis, usually occurs during birth, surgery, long aircraft or bus trips. Superficial thrombophlebitis can easily be detected on examination as hard, red and painful varicose veins. Superficial thrombophlebitis makes non-surgical treatments difficult, causes pain in the patient and carries the risk of embolism (migration to other organs), so it is important to recognize it during the examination.

 

In conclusion, in patients with varicose veins, valuable information can be obtained through a patient history and a simple examination. But a "good" color Doppler ultrasound examination is the key to a successful treatment.

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 Video: Why is Doppler ultrasound so important in varicose veins? 

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