Varicose veins are actually a common name for “chronic lower extremity venous disease”, and to be exact, varicose veins are one of the most typical manifestations of chronic lower extremity venous disease. That is to say, there are some other manifestations and signs of “varicose veins”, so I will talk about how to determine if you have “varicose veins” and what tests to do if you find “varicose veins”. “And what tests should be done to confirm the diagnosis.
There are many causes of varicose veins, it may be a simple lower limb vein disease, or it may be caused by some other diseases, its incidence in China is about 9%; the number of people suffering from the disease is large, some patients are found by the examination when the disease is more serious, the effect of treatment will be very poor, so early and timely detection of varicose veins is the key.
Nowadays, the main method to determine the degree of varicose veins is to use the “CEAP grading” determined by the American Venous Forum, which simply means that varicose veins are classified into 7 grades from C0 to C6 according to their manifestations. This grading method is useful for early detection of varicose veins, for determining the severity of varicose veins, and for treatment (only simple grading is described here so that the general public can understand it). The average patient can get a preliminary idea of their varicose veins by looking at the grading instructions and pictures, but the final diagnosis needs to be made by a doctor.
If varicose veins are at this level, patients usually have no obvious symptoms, many of them just feel discomfort in their legs when resting, most likely in their calves, which will be relieved after massage or exercise, but there is often nothing found when doing examination. The presence of such symptoms suggests that the patient may be in the early stages of varicose veins.
At level C1, the patient often shows signs of capillary dilation in the lower extremities, which can be seen as red lines or filaments on the lower legs; there are also signs of reticular veins (blood vessels distributed in a network and dilated) and flushing in the ankles, which suggest that the patient is at level C1 (Figure 1).
Figure 1 – Grade C1
In level C2, the superficial veins of the lower extremities, which are the veins closer to the skin, are permanently and permanently dilated, especially when the patient is standing, with significant varicosities and distortions (Figure 2). Patients who are in the pre-C2 category (C0 ~ C2) may not see these manifestations on their own, but they can be detected by the physician when they come to the hospital. Although some of these patients develop edema, most of them have superficial venous problems that can be relieved and prevented from progressing by wearing compression stockings, and not all of them require surgical treatment.
Figure 2 – Grade C2
When a patient is graded at level C3, there is significant edema in the lower extremities (Figure 3). This edema usually occurs around the ankle and may involve lesions in the deep veins (veins deep in the body), and depending on the physician’s diagnosis and the patient’s own needs, surgical treatment may be an option at this time.
Figure 3 – Grade C3
Patients with grade C4 generally have skin changes in the lower extremities (as in Figure 4) that manifest themselves in the following ways.
hyperpigmentation, which early on usually occurs around the ankle, with darkening of the skin, gradually progressing to the lower leg or foot.
Skin sclerosis, the patient may have scarring and sclerosis of the skin where varicose veins of the lower extremities occur, and sometimes there may be localized redness and tenderness of the skin, but usually there is no fever, which is a more serious skin change; eczema, blisters or erythema in the ankle or calf. Progression of the disease to this stage often requires aggressive surgical treatment.
Figure 4- Grade C4
When graded C5 to C6, varicose veins have progressed to a more severe stage. In addition to skin changes like those seen in grade C4, grade C5 has healed ulcers (Figure 5) and grade C6 has active ulcers (Figure 6), which tend to occur around the ankle (predominantly the inner ankle) and in the lower third of the lower leg. Patients in these two grades should have aggressive surgery, but surgery is only one of the treatment modalities, combined with compression therapy (wearing compression stockings) and, in some cases, long-term use of intravenous active medications.
Figure 5 – Grade C5
Figure 6 – Grade C6
In addition to symptomatic determination, further diagnosis of varicose veins requires a number of ancillary tests.
The most frequently used tool for examining venous disease of the lower extremities is “lower extremity arteriovenous ultrasound”, which has the advantage of being noninvasive, inexpensive, and can completely confirm the diagnosis of varicose veins. Moreover, ultrasound can determine whether the varicose veins are caused by primary disease or other diseases, and can determine the degree of varicose veins. Therefore, ultrasound is preferred to check varicose veins.
There are other tests such as phlebography, CT, MRI, etc., but they are mostly suitable for patients with some special conditions and are basically not used for general patients.
For patients with detected or diagnosed varicose veins, graded at C3 and before, surgery is not always necessary (it is necessary to combine the doctor’s judgment with the patient’s own treatment requirements), but wearing elastic stockings and regular observation is also possible. This observation does not necessarily require a trip to the hospital, but rather the patient’s own observation at home to see if the disease is progressing.