Varicose veins

Case contributed by Dennis Odhiambo Agolah


Varicose veins right greater than left. For both lower limbs venous ultrasound Doppler study. Patient currently managed with thigh-high compression stockings.

Patient Data

Age: 65 years
Gender: Female

Multiple tubular and tortuous anechoic superficial and deep subcutaneous vascular structures (varices) arises from the relatively engorged great and the lesser saphenous veins right from the proximal thighs up to the distal 1/3 calf regions. The varices measures up to 9 mm in diameter at rest. 

Positive color aliasing (venous regurgitation {pointed arrows}) is visible at the bilateral sapheno-femoral-sapheno-popliteal junctions on color flow Doppler interrogation suggesting valvular incompetence at the mentioned regions and there is sluggish intra-venous flow movement (stasis) bilaterally. No superficial or deep venous thrombosis or AVM. No subcutaneous lymphedema either.

Case Discussion

Grade IV multiple venous varicosities presenting as serpiginous anechoic subcutaneous structures and ranging up to 9 mm in diameters (at rest) and arising from the great saphenous and lesser saphenous veins and the bilateral peroneal veins noted within the lower limbs. The right and the left great saphenous veins measures 10.4 mm and 8.4 mm in diameters proximally respectively while the right and the left short saphenous veins measures 6.6 mm and 4.2 mm in diameters respectively proximally (at rest). 

Quantified reflux times at the common femoral and the popliteal veins of 0.48 seconds and 0.26 seconds noted are still within normal limits. No grossly dilated perforators bilaterally (both at rest and on erect positioning) and these features are compatible with severe bicuspids valvular incompetence involving the bilateral great and the lesser saphenous veins and the deep calf veins (saphenous subcompartments and the deep calves venous compartments) resulting into grade IV bilateral lower limbs venous varicosities.

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