Diagnosis of Varicose Vein

Diagnosis of varicose veins:

Clinical techniques to determine reflux such as the tourniquet and Perthes test have been superseded by the use of hand-held Doppler. For completeness, the two traditional examination techniques, I am mentioning here.

The tourniquet test is performed by laying the patient flat and emptying the superficial veins in the leg. A tourniquet is applied and the patient is instructed to stand . Absence of varicosities implies control of the site of reflux proximal to the tourniquet and implies a positive test.

Perthes test is performed by repeating the tourniquet test but allowing some blood into the leg. The patient stands up and down on tiptoes and emptying of the veins implies that the muscle pump is functioning.

Investigations done in varicose veins:

Hand-held Doppler evaluation

The tip of the Doppler probe is applied to the saphenofemoral junction and the calf is squeezed or varicosities are tapped with the fingertips. A single swoosh implies a competent valve and a double swoosh indicates an incompetent valve. The procedure is repeated at the saphenopopliteal junction.

Duplex Doppler evaluation

Duplex evaluation provides real time images with physiological data on blood flow which can be amalgamated to determine luminal and parietal diameter, compressibility, echogenicity, flow direction, and valve leaflet function of the vessel.

Colour duplex should be performed in all patients who have recurrent disease, skin changes, or a history of deep venous thrombosis (DVT) or thrombophlebitis. Patients presenting with venous flaring or telangiectasia should also have colour duplex as up to a third will have superficial venous insufficiency

Photoplethysmography

Patients noted to have both superficial and deep venous reflux should undergo functional testing to determine the relative contribution of each system to reflux. Photoplethysmography works on the premise that infrared light is absorbed in varying degrees based on the volume of haemoglobin present within the limbs, and measures venous refilling time as well as the efficiency of the calf muscle pump.

Varicose Veins - Causes, Symptoms and Complications
Diagnosis of Varicose Veins
Varicose Vein - Treatment and Prognosis