Varicose Veins: The Deeper Story

We have all seen those patient in our office with large ulcers over their ankles and have known immediately what needs to be done. However, how often have we stopped to think how they reached that point? Chronic vein disease is a spectrum of illness that extends all the way from spider veins to large venous ulcerations and it can range from asymptomatic to disabling.

So what is the process to identify those patients who may need additional investigations to limit their disease progression and therefore, suffering? Well, fortunately, the biggest step is one we do all the time and are good at – the history and physical exam. Since patients often think that all vein issues are cosmetic, you often have to specifically ask about their symptoms in order for them to make the association with their veins.

The following are the common symptoms to ask about: heaviness, aching, throbbing, tiredness, burning, itching, tingling, and cramping. Restless Leg Syndrom (RLS) is another often unrecongnized (even by physicians) symptom that is associated with chronic vein disease. Studies suggest that between 50-80% of patients with RLS have some component of venous insufficiency. Multiple episodes of phlebitis would strongly suggest that the patient would need further evaluation.

On physical exam one should look for unexplained edema, spider and varicose veins, skin changes such as lipodermatosclerosis, and ulcerations (both healed and active).

If patients have any of the above symptoms or findings on exam they can be referred to a Phlebologist (vein specialist) for a more fomal evaluation. By doing so, a significant amount of morbidity and complications can be prevented in our patients.