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, and the most recent evidence suggests that duplex US should be the first assessment of the lower extremity venous system 1. This unilateral presentation may be caused by factors specific to that leg, such as previous injury, surgery, or blood clot. 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. One-sided varicose veins don't necessarily indicate a more serious condition than bilateral varicose veins, but any asymmetrical swelling or vein changes should be evaluated by a healthcare provider to rule out deep vein thrombosis or other circulatory problems. Some key points to consider include:
- The exact pathophysiology of varicose veins 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, and prolonged standing 1.
- Treatment options include compression stockings, elevation of the affected leg, exercise to improve circulation, and in some cases, medical procedures like sclerotherapy or laser treatment 1.
- Compression therapy has been widely described as the best initial treatment for varicose veins, with a minimum pressure of 20 to 30 mm Hg recommended 1. If you notice pain, heaviness, skin changes, or worsening appearance of the varicose veins, seek medical attention promptly as these symptoms may indicate progression of venous disease, and the most recent evidence suggests that endovenous thermal ablation may have better outcomes and fewer complications than other treatments 1.
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.