Varicose veins: scan first, treatment second

The most suitable treatment for varicose veins cannot be chosen simply by looking at the veins on the surface. A proper assessment, including vascular ultrasound when planning treatment, helps identify the underlying problem and guides what to do next.

In this video, I explain why I start with the question of where abnormal blood flow is coming from. Two people may have very similar-looking veins but need different treatment plans.

Why are visible varicose veins only part of the picture?

Veins return blood towards the heart. In the legs, one-way valves help prevent blood from falling backwards between contractions of the leg muscles. When those valves do not work properly, blood can flow in the wrong direction. This is called venous reflux.

The bulging veins you can see may be the result of reflux elsewhere in the venous system. Treating a visible vein without understanding that pattern may leave an important source of the problem untreated. My guide to varicose veins and venous disease explains how reflux can contribute to aching, heaviness, swelling and skin changes.

What does a vascular ultrasound scan show?

A duplex ultrasound examines both the structure of the veins and the way blood moves through them. It helps map which veins are involved and where reflux occurs. The findings are interpreted alongside symptoms, examination and previous treatment rather than in isolation.

This mapping can distinguish problems in the main superficial veins, their branches and the deeper venous system. These distinctions matter: a visible cluster of veins does not automatically tell us which vessel should be treated or whether it is the main cause of the symptoms.

The scan therefore provides information that a photograph cannot. It gives the treatment discussion a basis beyond appearance alone.

Why might two similar-looking legs need different treatments?

One person may have reflux in a superficial vein that is suitable for an endovenous procedure. Another may have a different reflux pattern, previous vein treatment or additional venous problems that change the plan. Sometimes the visible veins are not the main issue.

I also consider what is troubling the patient. Discomfort during work, swelling at the end of the day, troublesome itching and skin changes raise different questions from appearance alone. Understanding the effect on daily life helps us decide what improvement treatment should aim to achieve.

Which treatments might follow the scan?

Depending on the findings, options can include endovenous laser treatment, radiofrequency ablation, medical glue or ultrasound-guided foam sclerotherapy. These approaches work in different ways to close an appropriate abnormal superficial vein so that blood can return through other functioning veins.

Some patients need a different procedure or a combination of treatments. Others may benefit from conservative management and review. No single method is right for every leg, and finding reflux does not mean everyone must immediately undergo an intervention.

The discussion should cover the expected benefit, possible complications, alternatives and follow-up. It should also explain whether treating the main source of reflux and treating visible branches would happen together or in stages.

What should I ask before agreeing to varicose vein treatment?

Useful questions include:

• Where is the reflux coming from, and does it explain my symptoms?

• Which vein would be treated, and why?

• What alternatives are suitable for my scan findings?

• What recovery, follow-up and possibility of further treatment should I expect?

A clear plan connects the ultrasound findings to your symptoms and goals. The name of a device or a treatment alone cannot provide that explanation.

When should I arrange an assessment in Singapore?

Consider vascular review if varicose veins cause persistent aching, heaviness, swelling, itching or skin changes, or if you are considering treatment. An ulcer, bleeding vein or sudden painful swelling needs prompt medical attention; sudden swelling should not simply be assumed to be ordinary varicose veins.

For an individual assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. I will relate your symptoms and scan findings to the options available. Scan first, treatment second: the aim is a plan that fits the actual problem.