From the Guidelines
Varicose veins on one side of the knee typically represent localized venous insufficiency, where the valves in the veins near that knee have become damaged or weakened. This unilateral presentation may be caused by various factors including genetics, prolonged standing, obesity, pregnancy, or previous injury to that leg 1. When valves fail, blood pools in the veins instead of efficiently returning to the heart, causing the veins to become enlarged, twisted, and visible beneath the skin.
Causes and Risk Factors
The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure 1. Risk factors include family history of venous disease; female sex; older age; chronically increased intra-abdominal pressure due to obesity, pregnancy, chronic constipation, or a tumor; and prolonged standing.
Symptoms and Complications
Symptoms of varicose veins include a heavy, achy feeling and an itching or burning sensation; these symptoms worsen with prolonged standing 1. Potential complications include infection, leg ulcers, stasis changes, and thrombosis.
Diagnosis and Evaluation
Duplex US should be the first assessment of the lower extremity venous system, as it is noninvasive and can assess the anatomy and physiology of the lower extremity venous system 1. The evaluation should include direction of blood flow, assessment for venous reflux, and venous obstruction.
Treatment Options
Treatment options include:
- Compression stockings (20-30 mmHg or 30-40 mmHg depending on severity) 1
- Regular exercise like walking or swimming for 30 minutes daily
- Leg elevation above heart level several times daily for 15-20 minutes
- Avoiding prolonged standing or sitting
- Medical interventions such as sclerotherapy, endovenous laser treatment, or radiofrequency ablation for more severe cases 1
- Surgery, although it is no longer the standard of care and is now recommended as third-line therapy after endovenous thermal ablation and sclerotherapy 1
It is essential to evaluate varicose veins by a healthcare provider to rule out underlying conditions like deep vein thrombosis or other circulatory problems, especially if accompanied by pain, swelling, skin changes, or if they appeared suddenly.
From the Research
Varicose Veins on One Side of the Knee
- Varicose veins on one side of the knee can be a sign of underlying venous insufficiency, which may be caused by reflux in the saphenous, perforator, or local "feeding veins" 2.
- The presence of varicose veins on one side of the knee may indicate a more severe form of chronic venous insufficiency, which can lead to skin changes, discomfort, swollen ankles, and leg ulcers 3, 4.
- The treatment of varicose veins on one side of the knee depends on the underlying cause and severity of the condition, and may involve surgical or non-surgical options such as endovenous thermal ablation, phlebectomy, or foam sclerotherapy 2, 5, 6.
- Factors that influence the choice of treatment modality for varicose veins include the clinical pattern of veins, patient expectations, facilities, cost, and whether treatment is carried out in the public or private sector 6.
Diagnosis and Investigation
- Venous duplex ultrasound in the erect position is the best practice for investigating leg varicose veins, and should be performed by a specialist trained in ultrasonography 2.
- Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol, or venography or cross-sectional imaging in men or women unable to have TVS 2.
Treatment Options
- Endovenous thermal ablation is the best practice for treating truncal vein incompetence, and may be combined with phlebectomy or foam sclerotherapy to treat bulging varicosities 2, 5.
- Significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach 2.
- Incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation 2.