Lately, I’ve been seeing a rash of patients for second opinions. Many of these patients went to another “vein center” and were told they had a positive ultrasound and they needed a procedure. When we perform the ultrasound at Vanishing Veinsit’s negative. Of course, the poor patient is confused. Who’s right? How can one center say that the veins are abnormal and another one says everything is okay?
Even worse, some unfortunate patients had an ultrasound performed on the leg that’s bothering them and just for good measure also had one performed on the other leg. They tell the poor patient – you – that the non-symptomatic leg also needs a procedure.
To clarify this matter,it’s necessary to review a little anatomy. How does the body get blood back from the legs? It’s an uphill battle, what with gravity always trying to keep the blood in the lowest part of your body. As always, your body is ingenious in finding solutions. As you move around during the day your leg muscles massage your leg veins. This action provides a propulsive force to move blood up your leg.
So, imagine we have a bit of blood near the ankle. The leg muscle pushes it up to the calf. Gravity wants to force it back down immediately. But, you have valves in the veins. The valves are one way. They allow that blood to enter the calf area from below but then they close. Now, the blood can’t move down. Then the leg muscles push this blood further up the calf where it is again kept in place by the next set of valves. And so on and so on until the blood leaves your leg above the groin.
But, what happens if the valves don’t do their job? Then the blood that moves up will not be kept up. Blood will start to pool in your leg. This pooling of blood leads to swollen veins that protrude above the skin. That’s what a varicose vein is. The condition where the valves don’t function properly is called venous insufficiency or venous reflux.
When your leg is assessed by ultrasound, we look for evidence of venous insufficiency. Remember the movement of blood back down the leg is most prominent when gravity pulls the blood against the valves. So, we have you stand up. Think of this as a stress test for your veins. You’re standing up so gravity is working against the valves and you’re not moving around, sothere is no propulsive force pushing the blood up.
If we stress the valves long enough,we can show reflux in most patients. There’s just so much that those valves can tolerate. An hour in that position will do it for most people. Enough stress, a long enough time standing up without moving, will demonstrate venous insufficiency in most people.
Voila, you need a procedure. Many people who come to see us after being seen elsewhere report that they stood for a full hour as part of the ultrasound evaluation. That’s not the way to do it. Twenty minutes is all you need. If you have to stress the valves for a full hour to bring out an abnormality, then it’s probably not important. Think about it. How often do you stand for an hour without any movement? If you’re on your feet for that long then usually you’re moving. If you’re not on your feet, then gravity isn’t pulling the blood back to your leg. It makes sense to evaluate the veins realistically.
At Vanishing Veins we never have you stand for an hour to bring out venous reflux. If we did, we would find more legs that need procedures. But, we’re not about doing as many procedures as our patients allow. We’re about doing as many procedures as our patients need, not as many as we can. If you have the ultrasound performed and you had to stand for longer than 20 minutes, then say Adios to that vein doctor. Beware, the false positive ultrasound.
– Dr. Greenwald