From the Guidelines
For a 65-year-old female with increased varicose veins and 1+ pitting edema in her feet, the most appropriate diagnostic testing is US duplex Doppler of the lower extremity, as recommended by the American College of Radiology 1. This non-invasive test is usually appropriate for the initial diagnosis of varicose veins and can help evaluate both the deep and superficial venous systems, assessing for venous reflux, obstruction, and thrombosis. The key benefits of this approach include:
- Evaluating venous valve function while the patient is standing to accurately assess venous reflux
- Assessing for deep vein thrombosis or other obstructive lesions
- Guiding treatment decisions, such as compression therapy, saphenous vein ablation, or sclerotherapy, as recommended by the American College of Radiology 1 Additional testing, such as basic laboratory work, including a complete blood count, comprehensive metabolic panel, and thyroid function tests, may be considered to rule out systemic causes of edema, but the primary diagnostic step should be US duplex Doppler of the lower extremity, as supported by the most recent evidence 1.
From the Research
Diagnostic Testing for Varicose Veins and Edema
The patient's symptoms of increased varicose veins and one plus pitting edema in her feet suggest chronic venous insufficiency, which is common in older adults, particularly women 2.
- Risk Factors: The patient's age and female gender are risk factors for chronic venous insufficiency and varicose veins 2, 3.
- Diagnostic Evaluation: A complete bilateral venous duplex examination is recommended to evaluate for deep vein thrombosis (DVT) and superficial and deep venous valvular reflux 4.
- Association with DVT: Varicose veins have been recognized as a risk factor for DVT, and primary valvular reflux may also increase the risk of DVT 4.
- Obesity as a Risk Factor: Obesity is an important risk factor for lower limb venous disease, including varicose veins, chronic venous insufficiency, and DVT 3.
- Clinical Classification and Treatment: A comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease is necessary for appropriate management 5.