THE diagnosis of varicose veins is through physical examination. The accuracy is their improved with the aid of a handheld Doppler (ultrasound instrument), which allows the examiner to listen to the blood flow. Of course, the most accurate and detailed test would be the duplex ultrasound exam, which provides an ultrasound image of the vein to detect blockade caused by blood clots and to determine whether the valves are still working properly or have evidence of reflux. Otherwise, plethysmography which is non-invasive and painless may also be done.

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Management includes:

l. Prescription compression stockings to reduce the symptoms of varicose veins, prevent and reduce leg swelling and decrease the risk of blood clots. These stockings offer appropriate counter-compression and are more effective than over the counter stockings.

2. Sclerotherapy involves injection of a sclerosing solution into spider, reticular and varicose veins. This is a minimally invasive office procedure. This blocks the veins which are unsightly, tortuous and ugly or not working well. The sclerosing solution gradually causes the disappearance of the unsightly veins. Patients may have to receive multiple treatment sessions for several months.

3. Ambulatory phlebotomy is also a minimally invasive procedure that can be performed under local, epidural or general anesthesia in an outpatient setting. Varicose veins are removed with small hooks through tiny skin incisions. Stitches are not used and the tiny incisions are pulled together with sterile paper-tape. Recovery is usually fast.

4. Laser treatments use a fine optical fiber that is advanced through a catheter into the saphenous vein. Laser energy is then delivered through the fiber which makes contact with the blood and the inner wall of the vein, and as the fiber is slowly withdrawn, thelaser energy is absorbed by the blood and vein tissue, sealing it shut. Again, the procedure can be done in an outpatient setting. Recovery time is usually fast with positive short and midterm results.

5. RF treatment involves controlled delivery of radio-frequency energy directly into a vein by a thin catheter causing collagen in the vein to shrink and the vein to close.

Once the vein is closed, blood is naturally rerouted by the body to other healthy veins. It has good results at two years with similar after-procedure pain, bruising, tenderness and recovery compared to other endovascular treatments. This can be done in outpatient setting.

The above management modalities are recommended by the Vascular Disease Foundation of America, which is a non-profit, educational organization dedicated to the reduction of disability and death from vascular diseases as well as improvement of vascular health not only of Americans but the whole world.

By the way, it is worth mentioning that vein stripping, which used to be the traditional (and, if I may add, the only treatment, during my med years) management of varicose veins, is rarely used today due to its complications, failure rates and the advancement of less invasive and more definitive procedures.