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Varicose Veins—How to Investigate

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Abstract

Varicose veins (VVs) are dilated, enlarged, and tortuous superficial veins that most commonly occur in the lower extremities. Lower-extremity VVs result from intravenous reflux of blood, in turn due to vein wall dilatation and valvular incompetence of superficial veins. The VVs are classified as per CEAP classification. It is important to find the anatomical extent and etiology-pathophysiology of VVs. A set of investigations are required to exactly know the type of VVs. It is especially important to know which system, superficial, deep, or perforators, is involved. Though color duplex scanning is the gold standard for the diagnosis of VVs, sometimes, other investigations come into play for arriving at a diagnosis especially if the deep venous system is involved and in cases of recurrent disease. This paper discusses the systematic investigational plan for the diagnosis of the VVs in suspected cases.

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References

  1. Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B (2006) Chronic venous disease. N Engl J Med 355:488–498

    Article  CAS  PubMed  Google Scholar 

  2. Raju S, Neglén P (2009) Clinical practice. Chronic venous insufficiency and varicose veins. N Engl J Med 360:2319–2327

    Article  CAS  PubMed  Google Scholar 

  3. Kostas TI, Ioannou CV, Drygiannakis I, Georgakarakos E, Kounos C, Tsetis D, Katsamouris AN (2010) Chronic venous disease progression and modification of predisposing factors. J Vasc Surg 51:900–907

    Article  PubMed  Google Scholar 

  4. Sritharan K, Lane TR, Davies AH (2012) The burden of depression in patients with symptomatic varicose veins. Eur J VascEndovasc Surg 43:480–484

    Article  CAS  Google Scholar 

  5. Souza Nogueira G, Rodrigues Zanin C, Miyazaki MCOS, Pereira de Godoy JM (2009) Venous leg ulcers and emotional consequences. Int J Low Extrem Wounds 8(4):194–196

    Article  PubMed  Google Scholar 

  6. Vikas AM, Rishit H, Akhilesh S (2015) Vitamin B12 and vitamin D deficiencies: an unusual cause of fever, severe hemolytic anemia and thrombocytopenia. J Family Med Prim Care. 4:145–148

    Article  Google Scholar 

  7. . Varghese R, Patel M, Rajarshi M. (2019) Role of vitamin D3 in the management of pain in c5- 6 chronic venous disease (CVD): need to include as an Integral Part in the treatment protocol. Abstract published in the Hungarian Journal of Vascular diseases XXVI, 2019/3 page 17. Presented at conference “Another Phlebology” held on 4–5 October 2019, Hungary

  8. Campbell WB, Niblett G, Peters AS et al (2005) Clinical effectiveness of hand held Doppler examination for diagnosis of reflux in patients with varicose veins. Eur J Vasc Endovasc Surg 30:664–669

    Article  CAS  PubMed  Google Scholar 

  9. Necas M (2010) Duplex ultrasound in the assessment of lower extremity venous insufficiency. Australas J Ultrasound Med 13:37–45

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pichot O, Menez C (2016) Role of duplex ultrasound investigation in the management of postthrombotic syndrome. Phlebolymphology 23:102–111

    Google Scholar 

  11. Yan Y, John S, Ghalehnovi M et al (2019) Photoacoustic imaging for image-guided endovenous laser ablation procedures. Sci Rep 9:2933. https://doi.org/10.1038/s41598-018-37588-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Lockhart ME, Sheldon HI, Robbin ML (2005) Augmentation in lower extremity sonography for the detection of deep venous thrombosis. AJR Am J Roentgenol 184:419–422

    Article  PubMed  Google Scholar 

  13. Sutter ME, Tumipseed SD, Diercks DB et al (2009) Venous ultrasound testing for suspected thrombosis: Incidence of significant non-thrombotic findings. J Emerg Med 36:55–59

    Article  PubMed  Google Scholar 

  14. Coleridge- Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A (2006) Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP consensus document. Part I. Basic Principles. Eur J Vasc Endovasc Surg 31:83–92

    Article  CAS  PubMed  Google Scholar 

  15. Fraser JD, Anderson DR (1999) Deep venous thrombosis: recent advances and optimal investigation with US. Radiology 211:9–24

    Article  CAS  PubMed  Google Scholar 

  16. Rosen MP, McArdle C (1997) Controversies in the use of lower extremity sonography in the diagnosis of acute venous thrombosis and a proposal for a unified approach. Semin US CT MRI 18:362–368

    Article  CAS  Google Scholar 

  17. Johnson SA, Stevens SM, Woller SC et al (2010) Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis. JAMA. 303:438

    Article  CAS  PubMed  Google Scholar 

  18. Evans CH, Allan PL, Lee AJ, Bradbury AW, Fowkes RCV, GR. (1998) Prevalence of venous reflux in the general population on duplex scanning: The Edinburgh Vein Study. J Vasc Surg 28:767–776

    Article  CAS  PubMed  Google Scholar 

  19. Bays RA, Healy DA, Atnip RG, Neumyer M, Thiele BL (1994) Validation of air plethysmography, photoplethysmography and duplex ultrasonography in the evaluation of severe venous stasis. J Vas Surg 20:721–727

    Article  CAS  Google Scholar 

  20. Baldt MM, Zontsich T, Stümpflen A, Fleischmann D, Schneider B, Minar E, Mostbeck GH (1996) Deep venous thrombosis of the lower extremity: efficacy of spiral CT venography compared with conventional venography in diagnosis. Radiology 200:423–428

    Article  CAS  PubMed  Google Scholar 

  21. Stein Paul D, Matta Fadi, Yaekoub Abdo Y, Kazerooni Ella A, Jennifer Ellis Cahill, Goodman Lawrence R, Dirk Sostman H, Hales Charles A, Denier James E, Weg John G, Ghumman Dilraj, Chan Kevin M, Woodard Pamela K, Kwun Yoojin (2010) CT venous phase venography with 64-detector CT angiography in the diagnosis of acute pulmonary embolism. Clin Appl Thromb/Hemost 16:422–429

    Article  PubMed  Google Scholar 

  22. Tamura K, Nakahara H (2014) MR venography for the assessment of deep vein thrombosis in lower extremities varicose veins. Ann Vasc Dis 7(4):399–403

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yock P, Fitzgerald P, Popp R et al (1995) Intravascular ultrasound. Sci Am Science Med 2:68

    Google Scholar 

  24. Raju Seshadri, Knepper Jordan, May Corbin, Knight Alexander, Pace Nicholas, Jayaraj Arjun, Miss Jackson (2019) J Vas Surg: Venous Lym Dis 7:428–40

    Google Scholar 

  25. Khanna AK, Singh S, Tiwary SK, Khanna S, Deshpandey S, Shukla RC, Kumar P (2020) (2020) Ambulatory venous pressure studies and its correlation with ceAP grading of varicose veins. Acta Phlebol 21:16–22

    Article  Google Scholar 

  26. Eklof B, Rutherford RR, Berghan J et al (2004) Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vas Surg 40:1248–1252

    Article  Google Scholar 

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Authors and Affiliations

  1. Silverline Hospital, Ernakulum, Kerala, India

    Roy Varghese

  2. Apollo-CVHF Hospital, Ahmedabad, India

    Malay Patel

  3. Mumbai, India

    Manjusha Rajarshi

  4. Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Ajay K. Khanna

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  1. Roy Varghese
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  2. Malay Patel
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  4. Ajay K. Khanna
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Correspondence to Malay Patel.

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Varghese, R., Patel, M., Rajarshi, M. et al. Varicose Veins—How to Investigate. Indian J Surg 85 (Suppl 1), 15–21 (2023). https://doi.org/10.1007/s12262-021-03093-6

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  • DOI: https://doi.org/10.1007/s12262-021-03093-6

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