Varicose Veins – Diagnosis

Diagnosis of varicose veins

Varicose veins below and above knee

As with all medical conditions, someone has to suspect that there is a problem before it can be diagnosed, and if there are obvious varicose veins on the surface of the legs, then the diagnosis is much easier!

However, “hidden varicose veins” can be much harder to suspect. Anyone with:
• aching legs on standing
thread veins visible on the legs
• swelling of the ankles
• red patches on the lower legs
• brown staining on the lower legs
• patches of eczema on the lower legs (but no eczema elsewhere on the body or arms)
• hard tender lumps on the legs (“phlebitis” or “superficial thrombophlebitis”)
• unexplained bleeding from ankles, feet or lower leg
is likely to have “hidden varicose veins” (venous incompetence and venous reflux) and should be tested.
Once the diagnosis of varicose veins or “hidden varicose veins” has been suggested, then the patient should be sent for a duplex ultrasound scan performed by a trained specialist. As with many medical tests, the accuracy of the test depends on 2 factors:
  • the equipment
  • the person doing the test
Modern duplex ultrasound scanners are incredibly accurate and are able to examine all of the veins in the legs including the blood flow within them. However although the machinery is excellent, if the person performing the scan is not trained and does not do them very regularly, then the accuracy is not likely to be as good as it could otherwise be. In the very best units, trained vascular technologists, nurses or doctors do nothing but duplex ultrasound scanning of veins day. In smaller units, the professionals who perform the scans also do scans of arteries or other ultrasound examinations, or have other duties such as outpatient clinics or operating. In these cases, the duplex ultrasound examinations are less likely to be as precise purely and simply because the person performing the scan has less practice every week.
To perform a successful duplex ultrasound scan for veins, the blood has to be able to reflux back down the veins with gravity. Therefore the heart must be higher than the foot and the best scans performed with the patient standing with the weight on the other leg, or on specialised couches where the patients can be tipped to be almost vertical. Some veins in the lower legs can be examined with the patient sitting down with their lower leg hanging over the side of the couch.
Ultrasound scans for varicose veins or “hidden varicose veins” can never be performed with the patient lying flat. Without the effects of gravity, it is impossible to see whether the blood is refluxing and hence to know whether the valves are working or not.

Next page: What is the treatment for varicose veins?

This website was last updated on 11/10/16.