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What is the ideal treatment for varicose veins?

Q: The veins on my calves as well as behind the knees are visible. I went to a surgeon regarding this 4 years ago. He got a doppler study for both lower limbs. The report said: Bilateral illiac veins (common and external) reveal normal colour flow, spectral trace, velocity measurements and normal response to Valsalva's manoeuvre. Bilateral lower limb veins i.e. the common femoral, superficial femoral, deep femoral, popliteal and the calf veins (anterior and posterior tibial and peroneal veins) reveal normal colour flow, spectral trace, velocity measurements and normal response to Valsalva's manoeuvre and distal augmentation. No evidence of deep vein thrombosis seen. Bilateral sapheno femoral and sapheno popliteal junctions appear competent. There is evidence of few superficial varicosities noted in the left mid calf region along with medial aspect. There is evidence of dilated incompetent perforators noted at the following levels:

  • Right mid calf level along with the medial aspect.
  • Left ankle level along the medial aspect.
  • Left above ankle level along the lateral aspect.
  • Left below knee level along the lateral aspect.

    Recently, I went to the surgeon again to check about the stage. He again got an ultrasound doppler for both low extremity venous. The report says: Both lower limbs including the common femoral, superficial femoral, popliteal, gastronemius, anterior tibial and posterior tibial veins show normal spontaneous blood flow, velocity, compression and augmentation. No deep vein thrombosis is seen. There is no evidence of deep venous incompetence. The sapheno-femoral and sapheno-popliteal junctions are competent on both sides. No obvious incompetent perforators are seen in the leg. The report further states that all the mentioned areas of incompetent perforators show no abnormality in the present scan. A prominent perforator without incompetence is seen in the left calf region posterity. What do both the reports mean? What is my situation right now? Has it improved? What should I do with regard to varicose veins?

    A:The scan report, on both occasions, is indicative of minor varicose veins. These veins are a result of weakness in the vein wall and associated perforator incompetence (leaking valve of the vein). In this situation if you wish to have treatment done then the options are: A) Injecting the veins with a medicine, which will help in shrinking of the vein. This is called Sclerotherapy. B) Surgical removal of the veins, which will physically remove the veins giving small incisions. This is not a serious condition and there is no danger to life. Should you wish not to undergo any of the above procedures then the only option is to wear a compression stocking during the period you are on your feet.

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