Although surface varicose veins are pretty obvious, the cause of varicose veins is deeper under the skin. It is a problem called superficial venous reflux. That is a defect in the one-way valves that keep blood flowing in the correct direction. Venous valves are delicate folds in the lining of the vein that open and close keeping blood flowing in the correct direction. In the legs, healthy vein valves direct blood from the foot upwards back towards the heart. When the one-way valves in the veins do not work properly, gravity can pull the blood downwards in the wrong direction. Whenever fluid flows in the wrong direction in the body, it is called reflux. So, for example, many of you may be familiar with indigestion caused by acid reflux and a hiatus hernia, well, varicose veins and nearly all the common vein conditions such as spider veins, varicose eczema and leg ulcers are caused by reflux in the superficial veins.
The only way to accurately diagnose vein conditions and their underlying cause is with a venous duplex ultrasound scan. This examination is performed with the patient standing and the deep veins, superficial veins and their connections are checked as well as the function of the valves. With a duplex ultrasound scan, problems such as obstruction and blockages as well as reflux and thrombosis can be accurately diagnosed and identified. A duplex ultrasound scan is the only reliable way to accurately diagnose the cause of vein conditions and it provides the information essential to formulate the correct treatment. NICE, the National Institute for Health and Care Excellence provides evidence-based national guidance on health matters and it recommends in its clinical guideline CG168 to use duplex ultrasound to confirm the diagnosis and to plan treatment. In its Quality Standard QS67 it also recommends that successful treatment should abolish reflux and the only way to confirm that this has happened is with a venous duplex ultrasound scan. So as you can see, ultrasound is necessary at all stages of vein diagnosis, treatment and aftercare.
Surprisingly, superficial venous reflux may exist in the absence of visible surface varicose veins. Reflux can cause ache, throbbing, tiredness or even symptoms such as restless legs. Medical problems such as varicose eczema and varicose ulcers can develop without visible varicose veins. As the superficial venous reflux is the underlying cause, and as venous duplex ultrasound is the only way to identify superficial venous reflux reliably, it is clear that everyone with suspected vein problems, including spider veins, varicose eczema, leg ulcers, phlebitis or even deep vein thrombosis must have a venous duplex ultrasound scan to establish an accurate diagnosis.
