It is important to understand that symptoms (heaviness, aches) do not necessarily correlate with signs of venous insufficiency (varicose veins, reflux on ultrasound examination). Many people have varicose veins and reflux without any symptoms and others complain of symptoms with no recognizable varicose veins or any reflux of their deep or superficial venous systems.

Even if there are varicose veins or demonstrable reflux of the Saphenous Veins, there is no assurance that removal of these refluxing veins will have any effect on symptoms.

Duplex ultrasound examinations are usually administered by ultrasound vascular technicians. The technicians' skills and expertise can vary as do their results. You should obtain detailed copies of all your ultrasound reports and compare them. If there is a wide variation in findings you need to discover which findings are accurate and which are not. Very often, people undergo Endovenous Ablation and Sclerotherapy treatments when they were completely unnecessary.

Published on Jul 11, 2012

You need to be evaluated in an accredited vascular lab by a certified physician who interprets the scans (RPVI credential). The accredited facility means that the tests are standardized and there are strict criteria for diagnosis and quality control. Once you get the exam, you should be treated by a certified vein specialist from the ABVLM.

In my office, we have an ACR-accredited vascular lab. The scans are done by myself (RVT, RPhS) or two other vascular technicians (RVT credentials). I am in the clinic and come in the room to talk to the scanners as they are doing the scans and offer advice. I officially read the scans using my RPVI (Registered Physician in Vascular Interpretation) credential.

I use that information and see the patient in consultation or follow up. I examine the patient. I make treatment plans. I happen to be certified by the American Board of Venous and Lymphatic Medicine. I am double board certified in surgery and thoracic surgery (cardiothoracic surgery).

Hopefully, you will find well-trained physicians/surgeons with ultrasound credentials in your area.

Published on Jul 11, 2012

This is an important question....

If the ultrasounds were performed while you were lying on your back, you should not trust findings of reflux. If you were standing and have had multiple scans with reflux, you may indeed have reflux. The bigger concern seems to be that you have no physical findings of varicose veins nor swelling (edema). Heaviness and aching are common vein-specific symptoms. If your symptoms are minimized with walking, wearing compression and elevating them above the heart, you may indeed have a vein problem that WILL benefit from treatment. The key here is that you have vein symptoms suggesting reflux, yet an ultrasound that has proven to be inconsistent.

You need a standing ultrasound with a credentialed ultrasonographer. If reflux is present and your symptoms improve with compression, walking and elevation, you will likely see a meaningful benefit from treatment. If you see no benefit from conservative therapy, you should not have treatment in our opinion.

Published on Jul 11, 2012

Welcome to the world of vein treatment. There are a lot of people who treat vein issues, but not many actually know what they are doing. With that said, based on your comments, it definitely sounds like you have vein issues of some form, especially given the fact that you have heaviness and aching in your legs. One thing you must understand: Vein disease is not the cosmetic issue that most people, including doctors, tend to believe; it is a primary venous circulatory defect. Cosmetic issues do not generate symptoms, thus the heaviness and aching. As for which specialist to believe, that can be a difficult question to answer without actually scanning your leg veins. One thing that I would say is make sure your vein doc is a "phlebologist," someone who treats vein disease. Vein disease is not a vascular surgery or general surgery or dermatology issue; it is a phlebology issue, which is a completely different speciality. Furthermore, the doc who is evaluating you should perform a more thorough ultrasound evaluation of your legs looking for reflux and should be able to show you what is and is not refluxing by actually showing you the ultrasound screen and explaining to you what you are seeing--pictures do not lie. That said, once you settle on the one you trust, in order for your symptoms to resolve, that doc needs to address "ALL" aspects of your vein structure, from deep in your leg all the way out to your skin. Only then can they adequately fix the venous circulatory issues that are causing your symptoms. A doc who only recommends treating your larger veins deep inside your legs and calls everything else at skin level cosmetic, really has no idea what they are doing. Find someone else. Trust your gut and find the doc who knows what they are doing.

Published on Jul 11, 2012

First of all, do both legs hurt? I don't care what the ultrasound shows; if a patient has no complaints, I'm not going to treat them. Too many people are being treated who don't require it. If they have complaints, do compression hose help? If not, then treatment will not probably help and the discomfort might well be musculoskeletal in nature. I do an orthopedic exam on these patients and frequently find arthritis, sciatica, etc., as the cause of "their" pain--even if they have varicose veins.

Published on Jul 11, 2012