Varicose Veins

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Signs and Symptoms

Symptoms of varicose veins in the legs include the following:

• Cramps in the legs at night
• Exercise intolerance
• Heaviness or numbness in the legs
• Pain along the course of a vein
• Rash on the skin, itching, skin discoloration
• Restless legs syndrome

Varicose veins can occur in other parts of the body, including hemorrhoids in men and women and varicoceles in men.

Complications
If untreated varicose veins worsen, dermatitis can develop into an inflammatory condition called thrombophlebitis. Also, increased back pressure in the veins can reduce blood flow to the skin, causing a breakdown (necrosis) of the skin, which can lead to non-healing ulcers.

Diagnosis

Diagnosis of varicose veins involves physical examination. Visual changes in the veins and skin of the legs are usually quite apparent. However, in order to determine the cause and develop the best treatment plan, diagnostic tests often are preformed.

The most common test performed is a Duplex ultrasound with color flow. This test uses the reflection and transmission of sound waves to form images of structures under the skin. Ultrasound is a very good test for identifying blood vessels, which appear as two parallel white lines (vessel walls) separated by black (blood).

The color flow aspect can be used to determine the direction of the blood flow. Blood flowing in one direction appears blue and blood flowing in the opposite direction appears red. This allows the physician to determine if the venous blood is flowing as it should from the superficial system to the deep system (via perforating veins that connect the superficial to the deep) towards the heart or is flowing in the opposite direction due to incompetent valves (refluxing). Ultrasound can also detect where the problem originates so that corrective action can be taken.

Ultrasound often cannot visualize veins located in the pelvis or in the deep venous system of the legs. In these cases, magnetic resonance venography may be used. Historically, venography without magnetic resonance (i.e., "dye" or contrast injected into the vein via a catheter) has been used; however, this invasive test has widely been replaced by Duplex ultrasound with color flow. It is sometimes used when the cause for varicose veins cannot be determined by the other modalities.

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