Varicose Veins II: Diagnostic Studies and Interprofessional Care

Varicose veins cause a heavy, aching sensation or pain after prolonged standing or sitting. Additional symptoms include itching or burning sensations in the legs, edema, nocturnal leg cramps, tingling, throbbing, and restless or tired legs. Discomfort often improves with walking or limb elevation.

Duplex ultrasound scan evaluates venous anatomy, valvular competence, and obstruction to diagnose varicose veins. It assesses whether the valves controlling blood flow are functioning properly and estimates the severity of valvular reflux. This non-invasive imaging modality is preferred over older techniques like venography.

Conservative treatment includes resting with limb elevation, performing leg-strengthening exercises such as walking, and wearing graduated compression stockings. Weight loss may also be indicated depending on the patient's overall health. These approaches help reduce symptoms and prevent progression without invasive procedures.

Sclerotherapy involves injecting a liquid or foam sclerosing substance, such as polidocanol, directly into the veins to chemically ablate them. This office-based procedure causes minimal discomfort and works on spider veins, smaller varicose veins, and perforator veins. It is particularly suitable for patients seeking less invasive treatment options.

Endovenous ablation, such as radiofrequency ablation, uses thermal energy inside the vein to collapse and seal it as the device is withdrawn. Laser ablation uses a laser fiber tip to achieve the same sealing effect. Both procedures are particularly suitable for larger veins like the great saphenous vein and have identical success rates.

Surgical interventions include high ligation and stripping, which involve ligating the entire vein and removing its incompetent branches. Ambulatory phlebectomy is an alternative technique that pulls the varicosity through a small incision and then excises the vein. Treatment choice depends on vein size, location, severity, and patient preferences.

All varicose vein procedures risk complications including infection, bleeding, and recurrence of varicose veins. Post-procedure care often includes compression stockings to aid healing and improve outcomes. Patients should be informed of these potential risks when selecting their treatment approach.