Patients often ask about management options for unsightly varicose veins

CLINICAL  SCENARIO

A 48-YEAR-OLD nurse presents with a 10-year history of varicose veins that are gradually getting worse. She complains of significant aching and swelling of the affected leg that gets worse with prolonged standing, especially at the end of the day.

She is currently well but has a maternal family history of varicose veins with the complication of thrombophlebitis and venous ulceration. She asks about her management options.

ASSESSING AND MANAGING VARICOSE VEINS

The diagnosis is straightforward when there are clearly visible dilated and tortuous vein segments. In less clinically apparent cases, ultrasound scanning (audio Doppler or visual Duplex devices) is required to assess superficial venous reflux or incompetence. Significant venous reflux or congestion may occasionally be detected in patients presenting with ‘mild’ looking varicose veins. Before treating varicose veins, a Duplex scan is required to map the entire superficial venous network so that no ‘hidden’ varicosities are missed. The map provides information on the degree of venous reflux or incompetence as well as vein lumen diameter. More severe disease is correlated with greater reflux and larger lumen diameters. Specific procedural options include vein stripping, ultrasound-guided sclerotherapy, endovenous laser ablation or a combination of procedures. In recent years, ultrasound guided sclerotherapy and endovenous
laser ablation techniques have become a popular alternative to this stripping procedure. Informed patient preference will help determine the specific treatment
option.

Dr Lim and Dr Elvy are set up to offer you the best results for your leg vein problems. At the forefront of Phlebology leg vein assessment and treatment since 1998. With over 10 thousand procedures performed we combine expertise with state-of-the-art equipment to ensure that you are in safe hands!

Download the Endovenous Laser and varicose veins (Medical Observer) article