Varicose Veins in Ajax: What a Venous Ultrasound Shows

“They’re only cosmetic.” That is one of the most common things people say about varicose veins, and for some people it is close to true. Plenty of adults have a few visible, twisting veins on their calves that never cause a moment’s trouble. For others, though, those veins come with aching, heaviness, swelling by the end of the day, itching or changes in the skin around the ankles. In those cases, the veins you can see are often a sign of something happening in veins you cannot see.

That is where a venous ultrasound comes in. If your doctor has referred you for one, this article explains what is going on inside a varicose vein, why an ultrasound is often the first test, what the scan is looking for and what the appointment is like for patients at our clinic in Ajax. For the basics of how blood flow imaging works in general, our explainer on vascular ultrasound covers sound waves and Doppler; here, the focus is on veins in the legs and the valves inside them.

One-way doors that stop working

Arteries carry blood away from the heart under pressure. Veins have a harder job. The veins in your legs have to return blood upward, against gravity, all the way back to the heart, and they do it with very little pressure behind them.

Two features make this possible:

• The calf muscle pump. Each time you walk, the muscles in your calves squeeze the deep veins, pushing blood upward. This is why the calf is sometimes called a second heart.
• Valves. Inside the veins are small, thin flaps that act like one-way doors. They open to let blood move toward the heart and close to stop it falling back down between muscle contractions.

When valves are healthy, blood moves upward in steps and stays there. When valves become stretched or damaged and no longer close properly, some blood leaks backward and pools in the lower part of the vein. Doctors call this backward flow reflux, and a long-standing problem with it is often called chronic venous insufficiency.

Over time, the extra pressure from pooled blood can stretch the vein walls. The veins nearest the skin bulge, lengthen and twist, and that is what a varicose vein is.

Spider veins, varicose veins and something in between

People use these terms loosely, so it helps to separate them:

• Spider veins are small, fine red, purple or blue lines just under the skin, often on the thighs, ankles or face. They are usually a cosmetic concern.
• Reticular veins are slightly larger, flat blue-green veins that you can see but not usually feel.
• Varicose veins are larger, raised and often rope-like veins that can bulge above the skin, especially when standing.

The appearance of a vein does not tell the whole story. Some people have large visible veins with few symptoms; others have more symptoms than their skin would suggest. That gap is one reason a doctor may want to look beneath the surface.

Who tends to develop them

Varicose veins are common, and several factors make them more likely:

• a family history of varicose veins
• increasing age
• pregnancy, including multiple pregnancies
• jobs or routines that involve long periods of standing or sitting
• carrying extra body weight
• a previous blood clot in a leg vein, which can damage valves

Women are often described as more likely to develop varicose veins, but men develop them too, and men sometimes put off seeing a doctor about them longer.

Symptoms worth mentioning to your provider

Varicose veins are not always a problem. But it is worth raising them with your doctor or nurse practitioner if you notice:

• aching, heaviness or throbbing in the legs, often worse at the end of the day
• swelling around the ankles that improves overnight
• itching or a burning feeling over a vein
• night cramps or restless legs
• darkening or brownish discolouration of the skin near the ankle
• skin that becomes thickened, hard or shiny
• a sore near the ankle that is slow to heal

Skin changes and slow-healing sores in particular deserve attention, since they can be signs of long-standing pressure in the veins.

When leg vein symptoms are an emergency

Some vein problems are urgent. A community imaging clinic is not the right place for these, and you should not wait for a booked appointment.

Call 911 or go to the nearest emergency department if you have:

• sudden shortness of breath, chest pain or coughing up blood, which can be signs of a blood clot that has travelled to the lungs
• a varicose vein that is bleeding and will not stop with firm, steady pressure and raising the leg

Contact a doctor urgently, the same day, or go to an emergency department if you have:

• new swelling, pain, warmth or redness in one leg, especially the calf, which can be a sign of a deep vein clot
• a vein that has become hard, hot, red and very tender

Our article on blood clots and deep vein thrombosis explains clot symptoms in more detail.

What a venous reflux ultrasound looks for

A venous ultrasound for varicose veins is not quite the same as one done to look for a clot. Both use the same equipment, but the question is different. Instead of asking “Is there a blockage?”, a reflux study is mainly asking “Are the valves working, and if not, where is blood flowing the wrong way?”

During the exam, the technologist typically looks at:

• The deep veins, to make sure they are open and to check how they are working
• The main surface veins, including the long vein running up the inside of the leg and the shorter one at the back of the calf
• The junctions, where surface veins join the deep system, since leaking valves at these points are a common source of varicose veins
• Connecting veins between the surface and deep systems
• The direction and duration of flow when the valves are tested

The result is often a kind of map of where reflux is happening and where it is not. If you and your doctor or a specialist are considering treatment, this map can be very important, because the right approach depends on which veins are involved. Varicose veins that return after treatment are also commonly assessed this way.

What the exam is like

Many people expect to lie flat for the whole scan, as they might for other ultrasounds. A reflux study can be different, because valves are best tested when gravity is working against them. Depending on the exam, you may be asked to stand, or to lie on a bed tilted so that your legs are lower than your heart. Your technologist will explain each position as you go.

To check the valves, the technologist may:

• gently squeeze your calf and release it, watching on screen what the blood does afterwards
• ask you to take a breath and bear down briefly, as if straining, which increases pressure in the abdomen and tests the valves higher up the leg
• move slowly along the inside of the thigh, behind the knee and down the calf, applying gel and light pressure as they go

You will likely hear the Doppler sound change as blood moves. A short whoosh after a calf squeeze is normal; a longer sound in the opposite direction can be one of the signs the technologist is looking for. There are no needles and no radiation.

Both legs may be examined, and the scan can take some time, since many vein segments are checked. Loose trousers or a skirt that are easy to remove can make changing simpler. If you wear compression stockings, they will need to come off for the scan, so ask our team when you book whether there is anything else you should do beforehand. Tell the technologist if standing for a while is difficult; they can give you time to rest.

After the scan

The images and measurements are reported to the doctor who referred you. They will go through what was found and talk about next steps. Depending on the findings and your symptoms, that might include reassurance, practical measures such as compression stockings, leg elevation and staying active, or a referral to a vascular specialist to discuss treatment options. Decisions about treatment are made with your health-care team, not at the imaging clinic.

In the meantime, many people find that a few simple habits make their legs feel better:

• walking regularly to keep the calf muscle pump working
• avoiding standing or sitting in one position for long stretches when possible
• raising the legs above the level of the heart for a short time during the day
• asking your doctor whether compression stockings are suitable for you before buying them, since they are not right for everyone

Booking a venous ultrasound in Ajax

Venous studies are part of our vascular ultrasound service at Unit 102, 300 Rossland Road East in Ajax. Exams are performed by certified technologists, and our team will confirm any preparation when your appointment is booked. Bring your health card and requisition. The clinic is on the ground floor with free parking, which helps if your legs feel heavy by the end of the day. Patients come to us from Ajax, Pickering, Whitby and across Durham Region.

To book, call 905-426-3111 or request an appointment. If you are not sure whether your requisition is for a reflux study or a clot study, our team can help you check when you call.