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Consultant Vascular Surgeon - Varicose and Thread Vein Expert
 

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Investigation of varicose veins and venous disorders

For more information on a typical varicose vein consultation please click here

Further information on the varicose veins can be found here

Duplex ultrasound

Duplex ultrasound is now considered the mainstay of modern varicose vein assessment and has largely replaced the ordinary hand-held Doppler.

Ultrasound is a non-invasive test which can be performed as part of the outpatient consultation. Duplex enables the examiner to picture the veins even when they are not visible on clinicall examination. The direction and amount of blood flow can be measured enabling an accurate diagnosis. The exact source of the varicose veins can be determined enabling the correct treatment to be tailored to each patient’s individual needs.

The main veins in the leg, the deep veins, lie deep within the muscles and are not visible on standard clinical examination but can be visualised using Duplex ultrasound.

Venous physiology tests

In certain conditions of the veins more specialised investigations are indicated. These are usually required for patients with more complicated abnormalities. These help Mr Gaunt assess whether varicose vein surgery will improve the venous function of the leg or, more importantly, ensure the venous function will not deteriorate after surgery.

These tests are performed by Mr Gaunt using specialised equipment and techniques and are known as venous plethysmography.

Venous refilling time

This test measures the resting venous pressure, how efficiently your leg muscles can pump the venous blood out of the leg and how quickly the venous pressure rises again when your leg muscles stop contracting. The effect of any proposed venous surgery can be simulated by inflating blood pressure cuffs at different positions on the leg and repeating the blood pressure measurements.

Maximum venous outflow

This test measures how quickly the venous blood leaves the leg and is used to diagnose conditions which cause an obstruction of the veins. Such patients may have a congenital abnormality of the veins or a deep veined thrombosis (DVT) in the past which damaged the veins resulting in permanently swollen legs and/or venous eczema, lipodermatosclerosis and/or venous ulceration.

Abnormalities detected by venous physiology tests can be investigated further using special x-rays of the venous system - venograms. Radiological dye is injected into the veins of the leg and x-rays are taken to show any structural obstruction and/or leakage of the veins. Special fine catheters can be inserted in to the veins to measure the pressure at specific points. Surgery can then be planned to correct these abnormalities.