Should you treat patients with CVI but no varicose vein? I am suffering from CVI diagnosed through ultrasound.

My symptoms consist of heavy, achy and tired legs. I have reflux of the GSV and some other veins. Morning is better than later afternoon. Elevation helps. Have NO visible sign on the legs. There are some veins protruding on the feet. Do you recommend vein closure procedure for patients like this? What are the chances they can benefit from the procedure? Will they be better off by wearing compression stocking than procedure? Still suffer with compression stocking.

Answers from doctors (6)


Mercy Imaging Centers

Published on Jul 07, 2016

I would. Visible varicose veins are an indicator of the problem, not the problem. The varicose veins are the tip of the iceberg; you have the iceberg with no tip. You should either wear compression stockings for life or have your refluxing and symptomatic GSV closed.

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Answered by Mercy Imaging Centers

I would. Visible varicose veins are an indicator of the problem, not the problem. The varicose veins are the tip of the iceberg; you have the iceberg with no tip. You should either wear compression stockings for life or have your refluxing and symptomatic GSV closed.

Published on Jul 11, 2012


VeinsPlus - Grand Ledge

Published on Jul 06, 2016

Most patients with symptomatic varicose veins do not know they have varicose veins until they undergo an ultrasound study. The GSVs are held against the leg muscle by a fascia. The branches that arise off of the GSVs are not held against the muscle and are much more superficial (closer to the skin). When the GSVs are affected by reflux and subsequently dilate, the dilatation puts pressure on the adjacent muscle, resulting in aching and tenderness. The excess blood volume within the GSVs also results in heaviness. The heaviness and lactic acid accumulation result in early leg fatigue. Over time, the GSVs cannot handle the sustained pressure and eventually the pressure is distributed backwards into the branches, resulting in stereotypical dilated tortuous visible varicosities. Hence, by the time individuals develop visible superficial branch varicosities, this is typically an indication that the GSVs were affected years prior. If you are not getting good resolution of your discomfort from the use of compression stockings, and your vein doctor feels you are a good candidate for vein closure, then I would recommend getting the thermal ablation procedure, as varicose veins typically worsen over time. Warm regards.

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Answered by VeinsPlus - Grand Ledge

Most patients with symptomatic varicose veins do not know they have varicose veins until they undergo an ultrasound study. The GSVs are held against the leg muscle by a fascia. The branches that arise off of the GSVs are not held against the muscle and are much more superficial (closer to the skin). When the GSVs are affected by reflux and subsequently dilate, the dilatation puts pressure on the adjacent muscle, resulting in aching and tenderness. The excess blood volume within the GSVs also results in heaviness. The heaviness and lactic acid accumulation result in early leg fatigue. Over time, the GSVs cannot handle the sustained pressure and eventually the pressure is distributed backwards into the branches, resulting in stereotypical dilated tortuous visible varicosities. Hence, by the time individuals develop visible superficial branch varicosities, this is typically an indication that the GSVs were affected years prior. If you are not getting good resolution of your discomfort from the use of compression stockings, and your vein doctor feels you are a good candidate for vein closure, then I would recommend getting the thermal ablation procedure, as varicose veins typically worsen over time. Warm regards.

Published on Jul 11, 2012


More About Doctor Laser Vein Center

Published on Jun 30, 2016

Hmm, the fact that compression stockings are not giving relief make me think that treatment of the venous insufficiency may not provide relief of the heavy, achy legs. It is also still possible that treatment might give relief. I would discuss this further with your surgeon.

Answered by Laser Vein Center (View Profile)

Hmm, the fact that compression stockings are not giving relief make me think that treatment of the venous insufficiency may not provide relief of the heavy, achy legs. It is also still possible that treatment might give relief. I would discuss this further with your surgeon.

Published on Jul 11, 2012


Advanced Vein Center

Published on Jun 28, 2016

Very hard to say how much you will benefit. Vein symptoms are usually worse at the end of the day.

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Answered by Advanced Vein Center

Very hard to say how much you will benefit. Vein symptoms are usually worse at the end of the day.

Published on Jul 11, 2012


Chicago Vascular & Interventional Institute

Published on Jun 28, 2016

This is a good question and helps to distinguish two major types of vein patients that we treat. Those with symptomatic CVI (with or without varicosities) and patients that are asymptomatic, but looking for cosmetic improvement.

We do start with compression stockings in almost all patients who have symptomatic CVI. It sounds like these are not helping you much. We perform vein closure (laser ablation) almost solely for patients who are symptomatic (achy, painful, swollen, tired legs or in more severe cases skin changes and ulceration). These patients very often do have varicosities or protrusions associated with their venous insufficiency, but not always. In fact, your veins protruding near your feet could very well be related to your GSV and other vein reflux. From our experience, the vast majority of patients with reflux in the superficial venous system (greater saphenous and/or small saphenous vein) experience significant improvement in their symptoms when the incompetent veins are closed. This includes those patients without visible varicosities.

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Answered by Chicago Vascular & Interventional Institute

This is a good question and helps to distinguish two major types of vein patients that we treat. Those with symptomatic CVI (with or without varicosities) and patients that are asymptomatic, but looking for cosmetic improvement.

We do start with compression stockings in almost all patients who have symptomatic CVI. It sounds like these are not helping you much. We perform vein closure (laser ablation) almost solely for patients who are symptomatic (achy, painful, swollen, tired legs or in more severe cases skin changes and ulceration). These patients very often do have varicosities or protrusions associated with their venous insufficiency, but not always. In fact, your veins protruding near your feet could very well be related to your GSV and other vein reflux. From our experience, the vast majority of patients with reflux in the superficial venous system (greater saphenous and/or small saphenous vein) experience significant improvement in their symptoms when the incompetent veins are closed. This includes those patients without visible varicosities.

Published on Jul 11, 2012


Beach Cities Vein and Laser Center

Published on Jun 27, 2016

Hi there. Well, the symptoms sound like those typically seen in patients with venous reflux. The fact that your symptoms are worse in the afternoon and that elevation helps, goes along with venous reflux. It would also be more convincing if you could say that your legs feel better with compression stockings on or not. If they do, chances are that treatment will improve your symptoms. One of the keys is the accuracy of the ultrasound that you had. The performance and interpretation of the duplex ultrasound is very important. Reflux in a short segment of a small vein in the calf, for example, is much less likely to be causing your symptoms than severe prolonged reflux in a large vein that starts at the top of the thigh (saphenofemoral junction). When in doubt, get a second opinion/second ultrasound.

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Answered by Beach Cities Vein and Laser Center

Hi there. Well, the symptoms sound like those typically seen in patients with venous reflux. The fact that your symptoms are worse in the afternoon and that elevation helps, goes along with venous reflux. It would also be more convincing if you could say that your legs feel better with compression stockings on or not. If they do, chances are that treatment will improve your symptoms. One of the keys is the accuracy of the ultrasound that you had. The performance and interpretation of the duplex ultrasound is very important. Reflux in a short segment of a small vein in the calf, for example, is much less likely to be causing your symptoms than severe prolonged reflux in a large vein that starts at the top of the thigh (saphenofemoral junction). When in doubt, get a second opinion/second ultrasound.

Published on Jul 11, 2012


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