How Do You Test For Chronic Venous Insufficiency?

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One of the commonly overlooked health diseases is chronic venous insufficiency. According to studies, this venous disorder affects about 40% of adults in the US, with a majority of them experiencing the appearance of unsightly varicose veins. However, visible veins are not the only symptoms of this venous disorder, and it’s important to get tested to check your vein health and rule out risks for chronic venous insufficiency

So what types of tests are commonly done for diagnosing chronic venous insufficiency? Some of the noninvasive exams for CVI are physical leg examination, venous duplex scanning, CT or magnetic resonance venogram, and venous occlusion plethysmography. For assessment of deep veins, invasive tests may be done such as venogram, ambulatory venous pressure, and intravascular ultrasound. 

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What Types Of Test Can Be Done To Diagnose Chronic Venous Insufficiency? 

Chronic venous insufficiency is a medical condition where the one-way valves in your veins are damaged. These valves have an important role in moving blood from your lower extremities to the heart. When they are weakened or impaired, the blood can reflux or flow backward and they can accumulate within the veins, and increase pressure in the vein walls.

The pooling of blood in the leg veins is what causes the prominent varicose veins in the calves, feet, and ankles. And when varicose veins and CVI are left untreated, they can progress to more debilitating symptoms like persistent pain, edema, or venous leg ulcers. 

To avoid potential complications, diagnostic and laboratory tests should be done to determine the exact cause of venous insufficiency and analyze the current severity of its symptoms. Most of these clinical tests are standardized and they are outpatient procedures that can be done in a hospital or vein clinic. Here are the different medical exams for diagnosing venous diseases: 

1) Physical examination 

During your initial consultation with a vein doctor, they may first conduct a physical workup to get a baseline diagnosis for your condition. For this examination, you will be asked to stand upright while the doctor visually inspects and palpates your leg for any evidence of abnormal swelling, bulging veins, the difference in leg size, and venous distention. If there is suspected venous reflux, your doctor may proceed with a Brodie-Trendelenburg test.

The Brodie-Trendelenburg test is done to check the function of the valves in your deep and superficial veins. During this examination, you will be asked to lie down and the doctor will elevate one leg and massage them to empty the veins. Then, they will place a tourniquet in the upper thigh and ask you to stand to monitor how fast the veins will refill. If the saphenous vein fills rapidly with the tourniquet, it can be a sign of valvular incompetence. 

2) Duplex ultrasound 

Venous duplex ultrasound or duplex scanning is one of the most common noninvasive tests for chronic venous insufficiency. It’s also said to be the gold standard in diagnosing various venous conditions including deep vein thrombosis and May-Thurner Syndrome. This exam combines two ultrasound technologies to monitor the blood vessels in the legs: 

  • Traditional ultrasound or B-mode imaging, which uses high-frequency sound waves to generate visual images of the blood vessels 
  • Doppler ultrasound, which records sound waves to analyze the flow of blood within the veins

This test can help look for any obstruction or presence of clots that cause the blood vessel disease. It can also identify potential vascular diseases like carotid arterial stenosis and peripheral arterial disease.

Here’s what you need to expect on your duplex imaging exam: 

  • You will be asked to lie down on the exam table, assuming the position where you’re on your back with hands firmly at your sides. 
  • The sonographer will apply a warm gel on your legs and they will guide a handheld transducer over the skin to examine the blood vessels. 
  • The images of your veins will be displayed on a computer monitor and you will also notice the flow of your blood in the visual graphs. 
  • The whole exam can approximately take 30 minutes and you can resume your usual activities right after.

3) Computed tomography (CT) or magnetic resonance venogram 

Magnetic resonance imaging (MRI) and CT venography are two of the advanced testing procedures for evaluating chronic venous insufficiency. Both of them are imaging tests that help doctors get a better visualization of the superficial and deep veins to look for damaged valves, blood clots, and compressed vein walls. 

The difference between the two tests is the technology used to generate the pictures. A CT venogram uses a series of X-rays to provide images of the vein structures and their surrounding muscles, organs, and soft tissues. Meanwhile, an MRI exam uses large magnets and radio waves to capture the pictures of the blood vessels. 

During the CT and MRI venography, the doctor will also inject a contrast dye into the vein to be able to capture the flow of blood and get an optimal image of any blockages or incompetence in the venous system. 

4) Venogram 

Also called phlebogram or phlebography, this diagnostic exam uses the X-ray imaging technique and intravascular injections of contrast material to observe your veins and monitor the blood flow. A venogram test may be done in different ways: 

  • Ascending venogram - this exam is performed to determine the presence of blood clots in your deep veins. It can help rule out possible deep vein thrombosis and post-thrombotic syndrome. 
  • Descending venogram - this test enables the doctor to assess the function of the one-way valves in your deep veins. It can help identify whether the blood is flowing in the right direction or if there is existing venous reflux. 

Both types of venogram are done in a reverse Trendelenburg position and the lower limb that will be examined is relaxed in a non-weight bearing stance. The contrast dye will be injected into the veins to generate images of the blood flow and vein structures. The tests will help conclude whether the valves are functioning properly and identify relevant evidence of leaky veins. 

5) Venous occlusion plethysmography  

A venous occlusion plethysmography or air plethysmography is another noninvasive test that can measure blood flow in patients with chronic venous insufficiency. It can also help confirm if you have venous reflux and check for blood clots that are blocking the veins. This examination typically uses pressure cuffs which are small lightweight devices placed on the lower extremities. 

During the test, you’ll first be asked to elevate your leg at a 45-degree angle to empty the deep veins. Afterward, you’ll be instructed to stand and the doctor will monitor the changes in the venous volume as the veins are refilled. If there’s rapid venous filling, it may suggest the presence of venous reflux and it can help your doctor quantify the severity of your chronic venous insufficiency condition. 

6) Ambulatory venous pressure 

An AVP exam is an invasive procedure for identifying the causes and symptoms of venous hypertension. During this diagnostic test, a needle is inserted to the dorsal foot vein and it is then connected to a transducer to measure the amount of blood pressure in the vessels. While it’s considered a gold standard in quantifying the blood flow within the veins, it’s rarely used nowadays in clinical practice due to its invasive nature. 

7) Intravascular ultrasound 

An intravascular ultrasound (IVUS) is another invasive testing technique that can help assess the venous system and look for any obstruction or damage in the vein structures. It’s a catheter-assisted procedure where the doctor will insert an ultrasound probe from the femoral vein to check the blood vessels. The images of veins are projected onto a computer monitor so that the doctor is able to clearly inspect the blood vessel. 

Once the testing is done, there may be a small wound where the incision for the catheter was created. The doctor may cover the opening in the skin with a tiny stitch or dressing to protect from infections. You may also notice some swelling or bruising where the catheter was placed but it should resolve within a few days. 

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What Your CVI Test Results Will Tell You 

The results of the examination will help the doctor to make an informed diagnosis and accurate classification of the severity of your chronic venous insufficiency symptoms. They will base your clinical severity score according to the CEAP system which is the standard in categorizing the progression of venous insufficiency. There are six stages under the CEAP classification and here’s an overview of what they mean: 

C0There are no visible or palpable signs of CVI yet. However, the doctor may already recommend some lifestyle modifications such as wearing compression garments, having regular exercise, and losing weight to support healthy blood flow and slow down the progression of the venous disease. 
C1 In this stage, you’re beginning to have small thread-like reticular veins or spider veins. You may receive vein removal treatments to get rid of their appearance. Wearing compression stockings for small leg veins can also help prevent severe CVI. 
C2 You’re starting to have bulging varicose veins on the skin. This stage can be further classified in 2 sub-categories: C2A, which means that your varicose veins are mostly a cosmetic issue with no symptoms; and C2S, which means that you’re also experiencing some degree of leg pain, swelling, heaviness, and itching. 
C3Along with poor blood circulation within your veins, having CVI can lead to excess fluid retention and result in signs of lower extremity edema or swollen legs. 
C4When inflammation gets worse, it can also result in some skin damage which can cause leg discoloration and changes in skin texture. You may begin to feel some areas on your skin beginning to harden or thicken and some black or brown marks may form as well. 
C5In this stage, you may have mild or healed venous leg ulcers. This condition should be immediately manageable with vein treatments to prevent them from getting worse.  
C6This last stage pertains to having active open sores or venous stasis ulcers. To remedy this, you may need medical treatment and wound dressings to avoid risks of skin infection. 

Why It’s Important To Get A Clinical Test for Vein Diseases 

Chronic venous insufficiency is a progressive medical condition and it’s hard to address the failure of the vein valves without proper vein diagnosis and treatment. Since this vein disorder can affect anyone, doctors recommend getting a regular venous screening to know the real issues behind your varicose veins. Here are some of the benefits of getting a test for venous insufficiency: 

  • It’s an important preventative measure to detect any hidden or existing medical issues that may be a risk factor for CVI
  • It helps address early signs of venous disorder and vascular disease to avoid a potential health complication
  • It helps determine the right treatment approach to cure chronic venous insufficiency 

Anyone with visible veins are ideal candidates to get a screening test for chronic venous insufficiency. Likewise, patients who meet the following criteria will also benefit from a diagnostic exam: 

  • Individuals who have a family history of varicose veins or any venous condition
  • Adults who are over the age of 55 are also at high risk for CVI 
  • Individuals who have a medical history of previous blood clots or venous thrombosis 
  • Women who have had multiple pregnancies 
  • Individuals who have to sit or stand for extended periods of time for their daily jobs 
  • Obese individuals and those who lack physical activity or living a sedentary lifestyle 

How Chronic Venous Insufficiency Can Be Treated  

Depending on what comes out from the tests, there are a variety of non-surgical treatment options for chronic venous insufficiency and varicose veins. Some of the commonly prescribed treatment for vein removal are: 

  • Sclerotherapy - in this procedure, a doctor injects a liquid or foam solution to close the diseased veins and reroute blood flow to healthy veins
  • Endovenous thermal ablation - this procedure uses heat from laser energy to destroy the damaged veins 
  • Radiofrequency venous ablation - this vein removal treatment relies on electric current to heat the vein walls until it shrinks and collapses 
  • VenaSeal - this vein closure system uses a medical adhesive solution which is injected into the vein and blocks the flow of blood to the affected veins 

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Getting regular medical workups and venous screenings are essential in helping detect early warning signs of health issues like chronic venous insufficiency. It’s important to keep your veins in healthy condition to avoid more serious vein problems that may affect your quality of life. 

At Vein Center Doctor, we offer outpatient services for vein consultations and non-surgical treatments. Our team of experienced doctors can provide an accurate diagnosis and recommend the best course of treatment to address your vein issues efficiently. Contact us now and schedule an appointment with one of our vein specialists.

Your First Step To Being Vein Pain Free

Find exactly what you need to get rid of your vein-related problems. Dr. Sood and the rest of our team at Vein Center Doctor are ready to help: schedule your free consultation today.

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