Chronic vein disease is disease of the veins (vessels that carry blood back to the heart) that usually affects the legs. Over time, the vein walls become weakened and stretched, causing the veins to bulge out and twist. Eventually the veins may become unable to pump enough blood back to the heart, causing blood to pool in the legs—a condition called Chronic Venous Insufficiency (CVI).
If you have varicose veins that cause pain, swelling, or skin changes, or experience any of the other symptoms of chronic vein disease, see your doctor right away. Treatments are available to relieve your symptoms and prevent serious complications such as blood clots.
An evaluation to see if chronic vein disease is the cause of your symptoms may include:
- A medical history and physical examination to look for signs of vein problems and other conditions that could be causing your symptoms
- A hand-held Doppler test done in the doctor's office to detect blood flow problems caused by vein disease
- Noninvasive imaging tests and physiological (functional) tests to examine the causes and severity of blood flow problems
- Sometimes, more detailed tests may be necessary in women with severe symptoms to determine if you need surgery or another procedure to treat vein disease
The first step in diagnosing chronic vein disease is a medical history and physical examination.
A medical history includes a complete review of any medical conditions you have, especially those that make you more likely to develop vein problems (such as obesity, pregnancy, or a history of blood clots in the veins). Your doctor will also ask about any medications you are taking (including prescription drugs, over-the-counter medications, and dietary supplements). The more over-the-counter pain relievers you are taking to control your leg pain, the more severe your vein disease is likely to be.
Your doctor will then perform a physical examination to check for signs of vein problems and see how well blood is flowing your legs. The physical examination will look for:
- Varicose veins:
- Leg veins that rise above the surface of the skin
- May appear flesh-colored, blue, or dark purple
- Usually have a cord-like appearance and may be twisted or bulging
- Often located at the back of the calf or inside of the legs
- May be tender when touched
- Swelling in the legs, ankles, and feet
- Slow or non-healing wounds on the legs (ulcers)
- Scaly, itchy rashes ( eczema) and thickening of the skin, or changes in skin color
Your doctor will also ask you about any symptoms you are experiencing. Although early vein disease often does not cause any symptoms other than tenderness in the varicose veins themselves, as the disease progresses many women develop more general leg symptoms. These may include pain, aching, heaviness, or cramping (often occurring in bed at night). You may experience itching, tingling, or burning rather than aches or pain.
Leg symptoms caused by vein disease are usually worse when standing and putting weight on the leg, and get better when you walk, lie down, or raise your legs above your heart. Swelling caused by vein disease is often better in the morning (after you have been lying down) and gets worse as the day progresses.
A hand-held Doppler test (also called continuous wave Doppler) may be performed by your doctor during the physical examination to determine if vein problems are causing blood to flow backwards towards the feet instead of towards the heart.1 This test is like a pocket version of the duplex ultrasound test, but it only reveals the sound of blood flow instead of pictures of the veins and blood flow through them.
For this test, the doctor will use a small probe placed lightly against your skin to listen to blood flow through your veins. She or he may also use the thumb or a rubber tube to close off the vein and see how blood flow responds.
A hand-held Doppler probe being used to examine a leg vein.
Image courtesy of The Whitely Clinic.
In many cases the medical history and physical exam are enough to make a diagnosis of chronic vein disease.2 However, your doctor may also order additional tests to confirm the diagnosis and identify the cause and exact location of vein problems, especially if your symptoms are severe.
The most common test to diagnose leg vein disease is a duplex ultrasound test, which uses sound waves (like those used to view the fetus during pregnancy) to produce images of the veins in your legs and the blood flow through them. The ultrasound test can identify the exact location of vein problems, see if they are caused by blood clots (DVT) or damage to the vein valves, and help choose the best treatment for your condition.3 Ultrasound is also used to monitor patients who have had a blood clot to make sure it is not causing long-term vein problems.1
Your doctor may also recommend a test called plethysmography (pleh-THIS-mog-ra-fee) to determine the severity of backwards blood flow (reflux) in the veins. This test uses an air cuff or a light sensor to measure changes in blood volume as your veins fill and empty. While the ultrasound test looks for blood flow problems in specific veins, plethysmography measures the flow of blood in the entire leg, giving a better overall sense of the severity of vein disease.1
Ultrasound can usually provide enough information to diagnose vein disease and develop a treatment plan. However, women with signs of severe blood flow problems, such as skin changes or nonhealing wounds, may need further tests to see if they might benefit from a surgical or other procedure to treat vein disease.
Further tests to evaluate vein disease include:
- Venography – This test uses X-rays and a dye injected into a vein on the top of the foot (or through a long, thin, tube inserted into a vein in the groin) to produce detailed pictures of the veins and blood flow through them. It can detect the presence, location, and severity of blood clots in the veins, and determine if problems with the vein walls or valves are causing blood to pool in the legs.
- Venous Pressure Measurements – This test measures the pressure of blood flowing through the vein using a needle inserted into a vein on the top of the foot or in the thigh. The needle is connected to a device that senses the pressure of blood in the veins and records a tracing of vein pressure as it changes. Measurements will be taken when you are standing still and after you perform toe-tip exercises or knee bends. Cuffs may also be used to close off and open the veins and see how blood flow responds. Changes in blood pressure in the veins provide information about the location and severity of backwards blood flow in the veins and can help plan treatment.
Chronic Vein Disease Testing Overview
What happens next?
If you have been diagnosed with chronic vein disease, basic treatment will include leg elevation and compression (using stockings, bandages, or a machine with inflatable cuffs) to encourage blood to flow back to the heart rather than pool in the legs. You will also need to make healthy lifestyle changes and may require medications to get your risk factors under control and prevent blood clots. More aggressive treatment may include procedures to treat varicose veins and surgery to correct problems in the deep veins of the leg.
See Chronic Vein Disease Treatment Overview to learn about treatment options to relieve your symptoms and prevent complications of vein disease.
- Nicolaides AN. Investigation of chronic venous insufficiency: A consensus statement (France, March 5-9, 1997). Circulation. Nov 14 2000;102(20):E126-163.
- Jones RH, Carek PJ. Management of varicose veins. Am Fam Physician. Dec 1 2008;78(11):1289-1294.
- Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs--UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg. Jan 2006;31(1):83-92.