Diagnosing Varicose Veins

NYU Langone doctors are experts at identifying varicose veins, which are raised, swollen, and twisted veins in tissue close to the skin. They tend to be blue or purple and are visible, most commonly in the legs. They develop as a result of venous insufficiency, which occurs when one-way valves in the veins that keep blood flowing toward the heart stop working properly.

In varicose veins, the walls of the veins weaken and stretch, causing the valves to leak blood. This can cause blood to flow in the wrong direction—toward the foot. Blood builds up in the veins, causing them to swell and, sometimes, become twisted.

Though the causes aren’t known, risk factors for varicose veins include obesity, prolonged standing or sitting, aging, pregnancy, and having a family history of the condition. Varicose veins can also be caused by a prior leg injury, including a minor one like hitting your leg on a table. Hormonal changes—such as those brought on by puberty, menopause, and birth control pills—may weaken vein walls. The condition is more common in women than in men.

Symptoms include achy, heavy, restless, or tired legs; leg cramps, particularly at the end of the day; and tenderness in the affected veins. Varicose veins can also lead to skin color changes and sores.

People with severe varicose veins have a slightly increased risk for developing deep vein thrombosis, a dangerous condition in which blood clots form in the veins. These clots can break loose and travel to the lungs, reducing blood flow to the organs. This life-threatening condition is called a pulmonary embolism.

Diagnostic Tests

Your NYU Langone doctor asks about your medical history and performs a physical exam. He or she checks the color, texture, and condition of the veins to determine if you have varicose veins. The doctor may also order an imaging test to assess the size of the veins and the direction of blood flow and to look for blood clots.

Duplex Ultrasound

A duplex ultrasound—which uses sound waves to create images of veins and blood flow—combines Doppler and conventional ultrasound techniques. The result is a two-dimensional, moving image of blood vessels. Your doctor may use this test to determine whether you have deep vein thrombosis, a serious condition that’s typically treated with blood-thinning medications called anticoagulants.

During this test, the technician places a warm gel on the legs or other affected area, then presses a handheld instrument called a transducer against the skin. It transmits sound waves that produce images of blood vessels on a computer monitor.

This painless exam takes about 30 to 60 minutes. You can return to your usual activities immediately afterward.