What to expect during your varicose vein ultrasound exam

So you have decided to get your veins checked out by a vein specialist~good for you! What can you expect during your exam?

Expect to answer a lot of questions. What are your symptoms? How severe are they? When did your symptoms begin? Have you had any work done on your veins or any surgery on your legs? Have you ever worn compression stockings? Did your symptoms begin when you were pregnant? (men, watch out for this one, it's a trick question for you) How active are you? Does your job keep you on your feet all day or sitting all day? Expect to answer regular medical questions too~chronic illnesses, medications you take, etc...

Your ultrasound exam should look at 2 different sets of veins in each leg: the Short or Lesser Saphenous Vein, which runs up the back of each calf like an old fashioned stocking seam, and the Greater Saphenous Vein, which runs from your ankle to your groin along the inner surface of your leg. In addition, the exam should take at least a quick look at your deep venous system in the groin area where the Greater Saph meets up with the Deep Femoral vein to make sure there are no blood clots hanging around the deep system.

Evidently this person is truly gender neutral. That's cool, it takes all kinds.

You will be asked to take your pants off for the exam, but don't worry, you will get a drape to cover up with. Because the examination of the Greater Saph goes all the way up to where your leg meets your torso you should wear loose or high-legged undergarments that will give your tech good access to the pertinent area of anatomy (officially called the "inguinal area". No, I am not making that up).

For those of you who have never has an ultrasound exam, I must tell you that you will get a bit goopy. The ultrasound uses what we ultrasound techs affectionately refer to as "goo" although it is officially called contact gel, which goes on your skin. This gel is necessary for the sound waves of the ultrasound to penetrate your skin and give us a good picture. The good part about this is that the gel is water based and therefore, is moisturizing and good for your skin. At least, that's what I tell myself to make myself feel better about being covered in it all day. Because the gel is water based it won't stain your clothing at all, so no worries about that.

Oh, and ultrasound is painless. Yea! How often does that happen at a doctor's office? I do apologize in advance for my cold hands. That happens in EVERY doctor's office, no help for that one.

Maybe I should switch from latex exam gloves to something cozier?

Your exam should include looking at the length of your veins all the way up and down the leg. Does the vein get smaller and larger or bulge at any point? Are there a lot of other veins coming off the saphenous vein, is the saphenous vein feeding blood to any varicose veins? Are there connecting veins coming up from the deep venous system that may be causing too much pressure in one spot of the vein?

The examination should include taking pictures and measurements of the diameter of the vein at several points along the way. Why measure the size of the vein? A vein that has no disease is likely to have a certain set of measurements that fit within a range of "normal". When we see a vein that is larger than it should be it is a good indication that pressure has been building up in the vein due to bad valves in the veins that allow blood to whoosh downwards inside the vein (venous reflux).

A transverse image of the vein will look like a black circle. This view shows you a "slice" of the vein, like a slice of bread instead of the whole loaf, get it?

An ultrasound exam of your veins can actually see and document venous reflux. Very simply, the ultrasound machine works by sending a stream of super-fast sound waves at very high frequencies into the body where they bounce off the tissues and bones and blood and whatnot inside you. The waves get bounced back to the probe where the computer in the machine coverts the sound wave data into a picture. Cool, huh? There is a Doppler setting on the ultrasound machine that can give a very accurate reading of blood flow that is moving inside the body, and it can represent the movement either with colors and/or a kind of a graph that lets you see blood flow in real time.

To get a possible reflux reading your technician will center the ultrasound probe along the length of a vein, then using either the color Doppler or the Pulsed Wave Doppler setting the tech can give your leg a squeeze on the vein somewhere below where the probe sits. The squeeze will force blood up towards your heart. If you're looking at the color doppler, you should see the "squeeze" as blue (that is blood flow moving away from the probe). In a healthy vein, you shouldn't see any other color after that squeeze, or maybe just a tiny flash of red.

This blood is the "squeeze", going up towards the heart

If you see a stream of red (that would be blood flow that is coming back towards the probe), what you are seeing is venous reflux, blood that is being allowed to fall back down the wrong direction in the vein. Bummer!

Uh oh, the dreaded reflux! That blood is headed the wrong way!

Sometimes your tech will have you stand for the Doppler portion of the exam in order to let gravity do it's thing and pull on the blood. If you have to stand, remember to keep the leg being looked at relaxed. Tensing up your leg muscle or moving at all will make it harder for your tech to get an accurate reading. Doppler reflux readings are a delicate operation for a tech that requires a very steady hand!

If you were having say, your kidney or liver examined, an ultrasound technician would not be allowed to tell you anything about your exam or the results. We're not doctors and can't diagnose anything so we have to stay mum about what we see. But perhaps your tech will have permission from their vein specialist doctor to show you what they are doing and explain everything during your venous exam for varicose veins. You should certainly ask!

The doctors I work for like their patients to be well educated about what is going on with their veins, so together the doctor and I walk them through the exam every step of the way and let them watch the ultrasound screen the whole time. By having a good understanding of what is wrong and talking with the doctor about their results and their options, the patient can make an informed decision about what course of treatment, if any, they want to pursue.

Varicose Veins 101

Ah, varicose veins. Those bulging, bluish, ropey road maps on the legs. Where do they come from? And what, exactly, is the medical issue? And how do your veins work, anyway?

Bummer case of varicose veins!

Let's start at the beginning, shall we? The average human body contains approximately 6 quarts of blood that get circulated with every beat of the heart through all the arteries and veins and capillaries of the entire body and back to the heart about every 2 minutes. That's a gallon and a half of fluid that has to travel through miles of vessels every 120 seconds! Amazing. Arteries carry the oxygen rich blood to every cell in the body, where your cells pick up oxygen and nutrients and put back carbon dioxide and waste into the blood.

Veins move the de-oxygenated blood from your feet back up through your legs to your heart where the blood will get circulated through the lungs, drop off carbon dioxide, pick up more oxygen, and get pumped out again to your body.

The circulatory system of , well, Mister Clean evidently

Veins are squishy tubes that have a series of valves in them. The valves open to allow blood to move upward towards the heart, then snap tightly shut to keep gravity from pulling the blood back down into your legs and feet. You can think of it kind of like an elevator that should only go up. Move up one floor, stop; move up one more floor, stop; all the way to the heart. ( "3rd floor, ankle!; 4th floor, tibia and fibula!; 5th floor, ladies haberdashery!") Blood traveling up from your legs has to be pumped along by the muscles in your legs, and the valves in your veins are the only thing keeping gravity from pulling the blood back down to your feet.

It's tough job, fighting gravity every day, but somebody's got to do it

Varicose Veins occur because of Venous Insufficiency Disease, which is a fancy way to say that the valves in your veins are not doing their job. When the valves don't shut tightly, gravity pulls the blood downward which causes pressure to build up in the vein, sometimes causing it to visibly bulge up out of the skin. This falling downward of the blood is called "reflux". The more the blood gets pulled down, the more the pressure damages the already failing valves. Building pressure may also cause the vein to stretch out, so eventually the valves may not even meet inside the vein, leading to more reflux, and the whole thing is a vicious circle. Feh!

Ooo, I hate it when a good valve goes bad!

Varicose veins and Venous Insufficiency are hereditary. If your parents or grandparents had them, there is a very good chance that you will develop them too. In my case, thanks, Grandma Anna. : ( Women are more likely to develop it than men, but honestly, I've seen plenty of men with large veins and bad reflux. In fact, many men wait so long to see the doctor that by the time they get to me for an ultrasound exam their disease is usually fairly advanced.

What's not under this kilt? Varicose veins

Reflux disease isn't just an old person's problem either. Would you believe that I have seen children as young as 9 who were complaining of painful legs who had some reflux? I have had patients as young as 19 and 20 years old decide to have their bad veins closed with the EVLT laser procedure because their symptoms were so bad!

It might surprise you to learn that Venous Insufficiency disease is not always visible to the naked eye. You can have bad valves in your veins and venous reflux and not have any visible signs at all. I've seen people with beautiful looking legs that had severe reflux disease. The only way to be 100% sure is by having an ultrasound examination of your veins that includes a doppler test to see if the blood is being allowed to fall back towards your feet.

See Jack. See Jack scan. Scan Jack, scan!

Exercise won't save you from Venous Valve problems either. My patients have included runners, aerobics instructors, yoga instructors, competitive bicyclists, lifeguards, and postal carriers. Exercise is vital for your calf muscle pump action and your over all health & well being too, so venous valve issues aside, do it anyway won't you?

There are some common symptoms of venous disease that should clue you in even if you don't see any bulging veins: heavy feeling legs, tired legs, painful legs, itching legs, burning skin, frequent night cramps, daily swelling of the ankles or calves, restless legs, the appearance of purple "spider veins". If you have one or more of these symptoms on a regular basis, get thee to a vein doctor for an exam!

Swollen ankles due to venous reflux disease? Not in this case

Have you ever seen older folks with bluish ankles? That's due to reflux disease that leads to blood pooling beneath thinning/aging skin. When that pressure gets bad enough and goes on for a long time, an older person may develop ulcers on their feet or ankles that won't heal, or the skin on their lower calf may become red and hard and leathery. It pays to treat your reflux before it gets to that point.

Don't let this happen to you

The old school of thought was that varicose veins were a cosmetic issue and you should just wear compression stockings and make the best of it. Or, God forbid, have a vein stripping and get all cut up and have a long recovery and a lifetime of scars! Now though, the medical establishment and medical insurance companies realize that Venous Insufficiency is a real medical problem and it can be serious. It has an impact on a person's health and the quality of their life.

Because Venous Insufficiency and Varicose Veins only get worse as time goes on, we will see more and more cases as our population ages. Thank goodness there are some good treatments out there now to help people deal with their venous disease.

Welcome, and thanks for reading!

Welcome, Dear Reader!

I'm so excited to share my adventures in varicose vein ultrasound with you! I have been helping doctors diagnose and treat varicose vein disease for a little over two years now, and it is extremely interesting and rewarding work. I adore my patients, and I feel good about the fact that I am helping to treat the cause of their problems and not just treating the symptoms or masking the problem with drugs.

Because of patient privacy laws I will be very careful to protect the identity and privacy of my patients in these posts. To that end, I will not reveal what doctors I specifically work for in the Southern California area nor will I reveal patient names. I DO hope to share with you, Dear Reader, some information about varicose veins in general and the wonders of the EVLT venous laser treatment that I participate in.

Be well!