Although the presence of varicose veins is usually obvious, a consultation is needed to precisely locate the source of the reflux (backward flow of blood), which may be some distance from the varicose veins themselves. The consultation with the specialist is thorough and unhurried. You will have ample opportunity to ask questions and every aspect of your care will be explained to you. A typical consultation has 3 main parts.
Your Medical History
The consultation starts with a thorough investigation into the history of your symptoms, general health, any previous treatment you may have had for your vein condition and also any medication you may be taking. You will have ample opportunity to discuss any concerns that you have.
The Medical Examination
In addition to a general examination, you will be examined to check the state of your legs, the extent of any varicose veins, any leg swelling or skin change such as varicose eczema. Your circulation and foot pulses will be felt by the specialist.
The Duplex Ultrasound Scan
This is an essential part of the consultation. Sound waves are used to build up a picture of the deep veins, the superficial veins under the skin and the varicose veins that may be present. In addition, the direction of blood flow in the veins can be detected with the ultrasound to diagnose sites and pathways of reflux. For more information, please visit the duplex ultrasound page.
Many people find a remote consultation by telephone to be a convenient method to have advice on their vein condition. A careful history followed by a review of photographs or images and then a telephone call can provide a diagnosis of the vein problem and a proposal for treatment in the majority of our patients. For people with leg vein problems and enlarged hand and arm veins, a remote consultation via the telephone is an attractive alternative to a visit to our clinic.
After a telemedicine consultation, patients can then attend the clinic, and undergo treatment in one visit. For those with enlarged hand veins, a duplex ultrasound scan is not required. For those with leg spider veins, the need for a duplex scan will have been discussed and a decision can be made prior to attending the clinic. For every other leg vein problem, a scan will be required.
The advantages of an initial telephone appointment prior to an in-person meeting is that it saves time and the cost of travelling. If after a telephone consultation, a patient does not wish to take the matter further, a report will be provided. If after a telephone consultation the patient wishes to proceed with treatment, the appointment can be expedited.
Telemedicine via email and the telephone is an option that many may wish to consider, while others will prefer to be seen by the specialist in-person and “face to face” before making any important decisions. The choice is yours.
More About Duplex Ultrasound
Colour Duplex Ultrasound is Essential in the Diagnosis and Treatment of Varicose Veins
Ultrasound has really revolutionised the way that doctors treat varicose veins and related conditions. We do not use just an ordinary ultrasound machine — the machine that you might be familiar with for diagnosing gallstones or looking at pregnant mothers and their babies — this is a special sort of ultrasound called duplex. Now what do I mean by “duplex”? Well the ultrasound builds up a picture of the structures the blood vessels the veins so that we can see it on the screen but then it also superimposes the flow of blood and the direction so that we can tell where there are problems with veins. Whether there are blockages whether there are problems with the valves and whether there is flow in the wrong direction so-called “reflux”.
When you come for your scan, the whole leg will be scanned from the top of the thigh down towards your ankle, even if the vein problems seem to be confined to one area. A water-based gel is used to allow the sound waves into the leg so that a picture of the vein and the blood flow in it can be built up. You will see in the video above a scan in which we are looking at the top of the leg where the main superficial vein joins the deep vein in the groin. And you can see the delicate little folds in the lining which in this case are not meeting properly and so when I squeeze the leg blood will go up which is the correct direction but when I let go because the valves are not meeting properly blood comes down in the wrong direction. We call that reflux. The ultrasound equipment is configured such that blood flow going up the leg looks blue on the colour duplex. When I let go there should not be any colour because the valves should be shutting and there should be no down flow of blood but in this case we can see that blood is coming down in the wrong direction and it shows as a red signal. In this scan, red on the duplex ultrasound shows us that there is reflux and it shows us exactly where that reflux is coming from.