Venous Insufficiency and Varicose Veins: Diagnosis and Treatment

Diagnosis

• A thorough history and physical examination are usually sufficient for diagnosis. Additional testing is generally reserved for severe cases or when surgery is planned.
• Ultrasound can be used to map the veins of the leg and identify areas of vein disease.
• Rarely, venography can be used to look more closely at the venous system. However, this test is invasive and more expensive that ultrasound. In general, it is used in patients who will undergo vascular surgery.

Treatment

• Bed rest, leg elevation, and compression stockings or bandages are the initial therapy in most patients.
• Intermittent compression pumps can be used for several hours daily and may be more effective than compression stockings or bandages.
• Several drug therapies have been used. Diuretics may be used in patients with severe swelling. Aspirin and antibiotics may be used to accelerate the healing of venous ulcers.
• Injection sclerotherapy is useful in many patients with varicose veins for whom conservative therapies have failed. This treatment consists of intentionally damaging the lining of the varicose vein so that the walls of the vein stick together. As a result, blood will no longer enter the vein, and it will disappear from sight.
• For patients with advanced disease that do not respond to other treatments, there are several surgical options that have high success rates.