Friday, 4 May 2012

Why Thread Veins need Duplex before Treatment

This lady in her 50s, came to have her thread veins treated at The Whiteley Clinic this week.

Apparently "simple" Thread Veins of the Leg 
She had been to one General Practitioner who had told her that they were cosmetic veins only and did not need treatment. This general practitioner had then given her "cream" telling her the veins with disappear.

Of course they did not, has thread veins of the legs cannot be treated successfully with cream of any sort.

More importantly, no doctor can ever pass judgement on veins without a duplex ultrasound scan showing exactly what is going on in the veins, deeper in the leg.

Apparently "simple" thread veins of the leg on standing
Fortunately, she saw a second general practitioner who is aware that almost 90% of people with "simple" thread veins have underlying venous reflux - or "hidden varicose veins".

Therefore she was referred for a full assessment to The Whiteley Clinic.

Although no varicose veins are visible on standing, a full venous duplex ultrasound scan was performed which is shown below.

Duplex ultrasound scan - X shows venous reflux 

The venous duplex ultrasound scan shows that the great saphenous vein (GSV) has venous reflux from the upper thigh all the way to the ankle. The patch of thread veins is coming straight off one of the branches (or tributaries) from this.

Therefore blood refluxing or "falling" down the great saphenous vein (GSV) is impacting directly onto the thread veins.

If this patient had gone to a cosmetic practice or beauty clinic which did not have a minimum of hand held Doppler but preferably colour flow duplex ultrasound, it is likely that she would have been offered treatment for the thread veins.

Treating these thread veins without treating the underlying cause first is highly likely to cause a disaster, with the patch of thread veins becoming either larger and more difficult to treat (telangetic matting) or brown staining with a progression to more thread veins in the future.
The thread vein course run by The Whiteley Clinic at The Clinical Exchange teaches all delegates why it is essential to perform Doppler examination as a minimum, and how to perform it correctly.
For anyone who has read "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers" you will be able to see that this patient has phase 1 passive reflux. As such a hand held Doppler at the groin alone would not have been enough to diagnose her.
This patient needs endovenous laser ablation or radiofrequency ablation of her great saphenous vein before her thread veins can be successfully treated.
For more discussion about this and similar cases, please see
For information about thread vein courses please see

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