Doppler ultrasound didn’t show insufficiency, but it did see varicose veins. Why and how to treat?

Question

The greater and lesser saphenous veins in both legs are ruled to be fine, but I do have a lot of varicose veins. How can I address these if the large vessels are fine?

Andres Zavala, DO · Answer

If you have a lot of varicose veins then more likely than not you have reflux in some of the saphenous veins. Was your ultrasound done in the standing position? A proper ultrasound evaluation should be done while standing because reflux is related to gravity and laying down even at a tilt can often yield false results. Other variables can also produce false negative results, for example if the room is too cold, if you are not properly hydrated or if you do an early morning study and had not been standing for any significant portion of the day, the veins may constrict (be too small) to adequately examine them. In addition,the experience of the ultrasound technologist is important, less experienced persons often miss reflux. Make sure you see a vein specialist and RVT that has a lot of experience doing venous ultrasounds.

Raffy Karamanoukian, MD, FACS · Answer

It’s important to distinguish between varicose veins and spider veins when choosing between laser therapy, sclerotherapy, and vein surgery. With two board certified vein specialists, our center uses a combination of visual examination, functional flow measurements, ultrasound, transillumination, and infrared light to map out vein networks prior to therapy. Lasers can be used to treat deep varicose vein insufficiency, vein perforators, and varicose veins. Sclerotherapy is ideal for spider veins and reticular veins. Whereas surgery is reserved for severely incompetent varicose vein segments.

Dr. Karamanoukian
Realself100 Surgeon

Dr. Karamanoukian
Realself100 Surgeon

Ramandeep Sidhu, MD · Answer

You can have varicose veins with mild reflux thats not considered significant or you could just have spider and reticular veins without any reflux. The best way would be to get the evaluation by a vascular specialist and if there is no reflux the treatment would be sclerotherapy for the prominent veins.

Megan Deacon-Casey, MD · Answer

Varicose veins are caused by underlying venous insufficiency/reflux in the superficial veins including the great and small saphenous veins. I would have the US repeated by a specialist; each case is unique and diagnosis is vital in assessing and treating venous insufficiency.

Lisa Perez, MD · Answer

It is highly unlikely to have bulging varicosities without any underlying venous reflux disease.  Typically if the saphenous veins are normal, then the reflux is coming from a perforator vein.  This is where an experienced registered vascular technologist is invaluable in making the diagnosis.  I would have the ultrasound repeated, and I agree with being well hydrated and avoiding caffeine.  Also I recommend standing for the ultrasound rather than lying down.  Make sure you are being seen by a practice that has an accredited vascular lab as well.

Manu B. Aggarwal, MD · Answer

Sometimes, you can have varicose veins without having underlying venous insufficiency. This is called C2 level disease. Based on the literature, you can elect to just wear compression stockings or actually remove the varicose veins. Remember, this is a genetic medical issue. It wouldn't be a surprise if they did come back over the next several years (not the ones removed, but new ones). I would make sure the folks during your ultrasound are Vein Center accredited so that you have the most thorough ultrasound done from professionals who have been vetted in this speciality care.

Ivan Brooks, MD · Answer

Various things can affect the reading of an ultrasound mapping of your venous system. This can include tech interpretation, time of day, done in standing vs laying down position, temperature in the room and anxiety levels during exam.  A repeat exam would be recommended. If the results are conclusive that no reflux exist in the saphenous system and there are no other associated factors such as leg pain, swelling and fatiguing over the course of the day, Sclerotherapy would be a great treatment option to help improve the cosmetic appearance.

Michael Nguyen, MD · Answer

Hi and thank you for your question! I recommend repeating Venous Doppler ultrasound. This time, try to be well hydrated, avoid caffeinated products prior to ultrasound imaging, exercise beforehand, be standing for reflux evaluation portion of the test, and make sure exam room and exam table are not too cold. By doing these above, you are preventing constriction of the vessels increasing the chances of finding retrograde flow in the deep veins, superficial veins, and perforator veins if reflux is really happening. Varicose or dilated veins is one of many signs and symptoms of venous reflux.Discuss with your specialist the possibility of treating your varicose veins with Ambulatory Phlebectomy  and/or ultrasound guided sclerotherapy.

John Landi, MD · Answer

If you have varicose veins then you should have valvular reflux.  If you have a lot of varicose veins then the reflux needs to be identified.  If you only have a few varicose veins then it may be harder to demonstrate the reflux but it should be there.  The quality of the ultrasound is often times dependent on the person doing it.  See a vein specialist .

Ramtin Massoudi, MD - Account Suspended · Answer

Hi Dear
I see this often enough, one of the most important in medicine is complete history and examination. If main branches like Great Saphenous Vein (GSV) and Small Saphenous Veins (SSV) are fine depending on bulging veins there might be perforating veins might causing these issues. *** when there is a leak there should be a source**** maybe ultrasound technician or doctor might miss but you can repeat the test standing and also is important t follow the varicosities and find the source.
Depending on the size of the veins either can be injected or removed.
Thank you
Ramtin Massoudi, MD

Doppler ultrasound didn’t show insufficiency, but it did see varicose veins. Why and how to treat?

Answers (11)

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