A 32-year-old woman presents to the vascular clinic with longstanding varicose veins. She reports that they developed after a complex tibial fracture several years ago. On examination, she has prominent truncal varicosities, with a long, tortuous long saphenous vein (LSV).
What is the most appropriate next step in her management?
Options:
A. Arrange a venogram
B. Arrange a venous duplex ultrasound scan
C. List her for a Trendelenburg procedure (high saphenous ligation)
D. List her for foam sclerotherapy
E. List her for multiple avulsion phlebectomies
Correct Answer: B. Arrange a Venous Duplex Ultrasound Scan
Explanation:
A venous duplex scan is the first-line investigation for varicose veins. It provides:
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A detailed assessment of valvular incompetence (reflux mapping).
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Visualization of both superficial and deep venous systems.
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Detection of any associated deep vein thrombosis (DVT).
The findings from a duplex scan are essential for deciding between surgical or non-surgical treatments.
Why Other Options are Incorrect:
| Option | Reason |
|---|---|
| A. Venogram | An outdated, invasive test. Reserved only for complex or inconclusive cases after duplex scan. |
| C. Trendelenburg Procedure | This is a surgical treatment. You must first confirm reflux and vein anatomy through duplex imaging before listing for surgery. |
| D. Foam Sclerotherapy | Suitable for smaller veins or specific patterns of reflux. Truncal varicosities, especially involving the long saphenous vein, require duplex evaluation to assess suitability. |
| E. Multiple Avulsion Phlebectomies | These are adjunct procedures to remove superficial varicosities, but not appropriate as a standalone treatment for truncal reflux. |
Clinical Pearl:
Always perform a duplex ultrasound before treating varicose veins.
It ensures the correct diagnosis, maps reflux patterns, and guides appropriate therapy.
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