Ultrasound Scan:
Varicose Veins

Varicose veins are enlarged, often curly (tortuous) veins which may be visible as dilated or bulging blue veins on the surface of the skin. Varicose veins can affect any part of the legs or pelvis. Varicose veins may occur in conjunction with small thread-like veins called spider veins (or telangiectasia) and slightly larger blue veins called reticular veins.

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In many cases varicose veins are not visible from the skin surface, however they can be detected on ultrasound. Varicose veins may initially occur without associated signs and symptoms, however if left untreated varicose veins may progress over time and cause problems in future.

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Varicose veins are the result from a condition known as venous insufficiency. Venous insufficiency refers to the valves no longer working correctly and become leaky. In a normal functioning vein one-way valves help push the blood against gravity and back up to the heart. If a valve becomes weakened or damaged, it is no longer able to close and causes the blood to pool in the veins. As the blood pools to the feet the veins become engorged and dilated. This extra pressure often causes the veins to buckle in on themselves and become curly. Over time the pressure builds up from the feet and up the leg; thus, giving the appearance as though the lumpy veins are growing up the leg.

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There are three common sites where the valves become leaky.

• Saphenofemoral junction (at the groin)

• Saphenopopliteal junction (behind the knee)

• Incompetent Perforators (can occur anywhere in the leg)

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To effectively treat the varicose veins, we must treat them from where the problem is starting - not just where we see the bulging veins. The best way to think of this is to imagine a running tap. If we ignore the running tap and only clean up the water on the floor, that is just a short-term cosmetic fix. But if we turn the tap off, we can then clean up the water properly.​

This scan usually takes between 15-20 minutes to complete. Very complex cases may require closer to 30 minutes.

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The purpose of this ultrasound is to assess for varicose veins and find where they are starting from. This ultrasound requires direct contact with your skin. The scan starts at the groin crease and the entire leg is scanned down to the ankles. We will require you to remove your shoes, trousers/shorts and we will provide you with a disposable gown. Dresses and skirts don't need to be removed and can be lifted out of the way.

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We will ask for you to sit on the edge of our examination bed which will be lifted so your leg can comfortably rest onto our lap, this relaxes the leg and gives the best results. During the scan we will apply ultrasound gel to your legs and use the ultrasound machine to look at the size, location and direction of the blood flow within the veins. We will need to periodically augment (compress) the calf and thigh to assess the blood flow.

A varicose vein scan assesses the competency of the deep and superficial veins; ie. we check to see what direction the blood flow is moving. By determining which veins are incompetent, their size and their pattern we can determine which treatment would be best suited to your veins. By treating varicose veins we can aim to help reduce or fix symptoms relating to varicose vein (such as swelling, aching, skin changes, ulcers), prevent symptoms before the occur and also get rid of the bulgy appearance of the veins.

Varicose veins are enlarged, twisted veins that commonly occur in the legs and can cause discomfort or pain. Several factors contribute to the development of varicose veins, including:

Age

The risk of developing varicose veins increases with age. As people get older, the valves in their veins may weaken and fail to function properly, leading to vein enlargement and varicose vein formation.

Gender

Women are more likely to develop varicose veins than men. Hormonal changes during pregnancy, premenstruation, and menopause can contribute to the development of varicose veins. Additionally, hormonal treatments such as birth control pills and hormone replacement therapy may increase the risk.

Family History

There is a genetic predisposition to varicose veins. If a close family member, such as a parent or sibling, has varicose veins, the likelihood of developing them is higher.

Obesity

Excess weight puts additional pressure on the veins, especially in the legs and abdomen, making it harder for blood to flow properly. This increased pressure can contribute to the development of varicose veins.

Prolonged Standing or Sitting

Occupations that involve long periods of standing or sitting can impede blood flow and increase the risk of developing varicose veins. Gravity makes it more difficult for blood to flow back up to the heart, leading to pooling in the veins.

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Pregnancy

Pregnancy puts increased pressure on the veins due to the expanding uterus. Hormonal changes during pregnancy can also relax vein walls and valves, making them more prone to enlargement and varicose vein development.

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History of Blood Clots

A history of deep vein thrombosis (DVT) or other blood clotting disorders can damage the valves in the veins, increasing the risk of varicose veins.

Lack of Physical Activity

Regular physical activity helps promote healthy blood circulation. A sedentary lifestyle, on the other hand, can contribute to poor blood flow and increase the risk of varicose veins.

While these risk factors increase the likelihood of developing varicose veins, it's important to note that varicose veins can develop even without any identifiable risk factors. If you have concerns about varicose veins or if you are experiencing symptoms, it is advisable to consult a healthcare professional for a proper diagnosis and appropriate management.

The symptoms of varicose veins can vary from person to person. Some individuals may experience mild symptoms or no symptoms at all, while others may have more pronounced discomfort. Common symptoms associated with varicose veins include:

Visible Veins

Varicose veins are often visible as enlarged, twisted veins that are blue or dark purple in colour. They may appear bulging or raised on the surface of the skin.

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Leg Pain, Aching and Discomfort

Many people with varicose veins experience pain or aching in the legs. This discomfort may worsen after prolonged standing or sitting and may improve with leg elevation or rest.

Leg Heaviness and Fatigue

The legs may feel heavy, tired, or fatigued, especially at the end of the day or after physical activity.

Swelling

Swelling, also known as edema, can occur in the ankles and lower legs. The swelling may be more pronounced after prolonged periods of standing or sitting.

Itching Burning and Irritation

Some individuals may experience itching or a burning sensation over the affected veins.

Skin Changes

Varicose veins can cause changes in the skin, such as discolouration, hemosiderin staining (port wine staining), darkening (hyperpigmentation), or the development of red or brown patches. The skin may also become dry and more prone to irritation or inflammation.

Tissue scarring, fat necrosis and contracture - lipodermatosclerosis

Leg Cramps

In some cases, varicose veins can be associated with leg cramps, particularly during the night.

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Restless Legs Syndrome

Restless legs syndrome (RLS) is a condition characterised by an uncomfortable urge to move the legs, often accompanied by uncomfortable sensations such as tingling or crawling. Varicose veins can sometimes contribute to or worsen RLS symptoms.

Ulceration

It's important to note that varicose veins can progress and lead to more serious complications, such as venous ulcers or blood clots. If you experience severe pain, skin ulcers, significant swelling, or any other concerning symptoms, it is advisable to seek medical attention for proper evaluation and treatment.

There are several treatment methods available for varicose veins.

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Stripping

This method of treatment is the most commonly known. It used to be the go-to procedure for the treatment of varicose veins, however as new and less invasive techniques have since been developed stripping tends to be reserved for particularly large (>20mm in diameter) and very tortuous varices. This procedure in done at a hospital with the patient asleep. The veins are physically removed (stripped) from the leg with a number of small incisions being made. The legs are bandaged afterwards.

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Radiofrequency Ablation (RFA)

RFA is considered a minimally invasive technique and is commonly performed in the doctors' rooms. Many people tolerate this procedure well with local anaesthetic only and numbing cream applied prior to the procedure, however the surgeon may recommend sedation in hospital for people particularly fearful of injections. Using ultrasound guidance, a small single incision is made and a catheter is inserted into the diseased vein. A cold solution containing more anaesthetic (tumescence) is injected around the vein being treated. This solution acts as a heat sink and ensures the area is numb so you won't feel anything during the heating process. The catheter is turned on and uses radiofrequency to generate heat and reaches 120 degrees over 20 seconds. The catheter is moved down the length of the vein and is turned on again; usually in segments of 3 or 7cm until the whole vein has been treated.

Limitations:

• RFA requires at least a 3cm length of straight vein as the catheter cannot bend.

• The remaining curly (tortuous) varicose veins will need to be treated using either sclerotherapy (most common) or multiple stab avulsions (physically removing).

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Ultrasound Guided Sclerotherapy (UGS)

Sclerotherapy is a liquid solution which has been proven to treat varicose veins. It is administered through an injection into the varicose vein. The sclerotherapy solution reacts with the vein walls and damages the integrity of the vein, resulting in a (purposely created) clot within that vein. Over time the body reabsorbs the vein (including the clot) until it is no longer visible.

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Microsclerotherapy

This is a very similar technique to ultrasound guided sclerotherapy, however on a much smaller scale. Microsclerothtrapy targets the very small spider vein and is usually done mainly for cosmetic reasons.