Varicose veins are diagnosed by a physical examination of the legs, focusing on assessment of pain in the legs. The examination is performed while the patient is standing. Through this assessment, the physician aims to determine location, type, extent and possible cause of the varicose veins. The medical provider investigates the patient for skin redness (erythema), tenderness, or skin hardening (induration). These are signs of a blood clot in the superficial veins. The exam will also involve identification of other signs of chronic venous diseases such as:
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- Edema (swelling)
- Hyperpigmentation (darkening of a patch of skin)
- Lipodermatosclerosis (inflammation of fat under the epidermis of the lower extremities)
- Atrophie Blanche (raised painful purple skin)
- Ulcer formation
Following the physical examination, the patient may undergo the Brodie-Trendelenburg test to determine if the type of vein affected is deep or superficial. To perform the test, the patient lies down with their legs elevated at a 45-degree angle. Once the veins are drained, a tourniquet is placed around the thigh. The patient then stands up. If the veins located far away from the tourniquet fill up quickly, the patient likely has a deep venous insufficiency. Once the tourniquet is removed if the superficial veins fill up quickly, a superficial venous insufficiency may be present.
To determine whether the varicose veins are caused by a deep venous insufficiency or an obstruction in the veins, the Perthes test is performed. The test involves applying a tourniquet to thigh while the patient is standing. The patient then walks around for 5 minutes. If walking becomes painful or the varicose veins become more visible, an obstruction is likely to be present. If the varicose veins disappear, that means that the veins are functioning correctly and unobstructed.
If the results of the physical exam and testing are not clear, a venous ultrasonography may be performed to determine whether the valves in the veins are functioning correctly or if there is a blood clot in the veins. This technique will elucidate the presence of superficial or deep venous reflux and the presence of superficial or deep venous thrombosis.
If the iliac venous segment (large vein in the leg) or inferior vena cava (large vein in the abdomen) are affected, additional imaging techniques may be applied, such as computed tomographic (CT) and magnetic resonance (MR) or invasive venography.