The diagnosis of venous insufficiency and
superficial varicosities is not difficult.
The varicosities are usually very evident
on just looking at the patient, particularly
if they’re standing because the veins will
fill and be very clearly seen.
There’s often a very simple test to see
whether these varicose veins fill from an
internal source or an external source. And
often one can do that by just compressing
the vein at its origin and seeing how easily
it fills. If you compress it low down and
it doesn’t drain and continues to fill,
it means it’s often connected to a deep
venous insufficient system. Although you may
remove it surgically, you still are stuck
with the problem of internal deep venous insufficiency.
For deep venous insufficiency, there’s a
test known as the Trendelenburg Test in which
one notices the dilation of the veins and
the blueish colour that goes with poor drainage
of the veins. You then lift the leg up – you
put the patient on a table, lie them down
and you lift the leg up and you see how quickly
the vein drains. In other words, how quickly
it disappears to obvious inspection. And,
usually, if it takes more than three seconds,
it means that there’s fairly extensive internal
Of course, one can also image these with ultrasound
and so forth. And very often, before one plans
any kind of major vein surgery, a very careful
ultrasound or even MRI study will be done
to understand the full aspects of the anatomy.
Therapy: for mild varicosities, simple surgery,
elastic support stockings or leggings that
compress the veins and prevent them from distending
or dilating. In fact, this is often something
I recommend to my patients who are going on
long plane flights that they definitely wear
elastic support stockings when taking a long
plane flight. Something I do myself.
I mentioned before sclerotherapy or scarring
therapy consist of injecting of a sclerosing
or fibrosing agent into the varicose vein.
And it’s used mostly for small varicose
veins and they just scar down and disappear.
If they’re large and very unsightly, they
may be removed surgically. And you still are
going to have venous drainage from your leg
because remember the venous system is redundant.
There are many possible channels. So removing
one vein doesn’t mean that the blood won’t
get out of your leg.
Chronic venous insufficiency is much more
dangerous because this is a condition that
can lead to deep venous thrombosis and pulmonary
embolism and venous ulcers in necrotic areas
of the skin.
Compression therapy helps with the putting
on of compressive dressings, elastic bandages
that really compress the leg more powerfully
than using elastic stockings.
Often we will use medications such as aspirin
to prevent a blood clot from forming. Aspirin
is a mild blood thinner. Or pentoxifylline
which actually improves the way red blood
cells pass through the capillaries.
And, of course, surgical therapy may be needed:
skin grafting to cover ulcers.
And recently a number of growth factors – biochemical
growth factors – can be placed on ulcers
or even given by injection. And there are
now specialists who deal with venous disease
and all of its complications.