Venous insufficiency is the condition that causes varicose veins. The venous system is a one-way vascular system designed to return blood form the body to the heart. Blood is pushed through the veins by the contraction of the surrounding muscles. Veins have one-way valves within them to prevent the blood from flowing the wrong direction by gravity and causing high pressure and pooling of blood, especially in the lower limbs. It is usually the failure of these valves that causes venous insufficiency. Another cause may be venous obstruction.
Instructions
1. Perform a history and of the patient. Visually examine the legs for visual signs of venous varicosities, edema and swelling, skin changes and venous stasis ulcers. The physical exam should locate the level or position of the underlying venous problem.
2. Perform a imaging of the suspected location. The duplex ultrasound used in the B-mode is able to give an image of the underlying structures and use a Doppler wave to detect the direction of blood flow. Most vein specialists, called phlebologists, will be able to perform this exam in their office. If this service is not available in the physician's office, the patient will be referred to an imaging service.
3. Position the patient on the examination table. Expose the area to be scanned. Apply ultrasonic gel to enable the ultrasound probe to be sealed to the skin for a better imaging. Scan the area until the expected valve can be visualized. Using the Doppler mode, determine which direction the blood is flowing.
4. While imaging the valve within the vein, take computer measurements in the ultrasound machine that will determine the length of time the valve remains open and closed. A faulty valve will remain open for a longer period than normal, and the blood will flow in the reverse direction.
5. After the exam, give the patient the results and recommendations on treatment. Treatment may include wearing compression stockings or performing a laser treatment to seal the valve closed.
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