How can varicose veins be assessed

Varicose veins: examination methods & diagnosis

Many people with varicose veins go to the doctor late or not at all, because varices are not a disease for them, but only an optical problem. In fact, however, the symptoms of severe varicose veins can significantly affect the quality of life. So if you discover conspicuous varicose veins on your legs, you should consult an internist or angiologist if possible. A phlebologist or a suitably experienced family doctor can also be good contacts.

Medical history & physical examination

The doctor will first find out about the existing symptoms, any family history and risk factors. Pre-existing neurological or orthopedic illnesses can also be important. Then the legs are examined, palpated and the various types of varicose veins, their severity and distribution pattern and any skin changes are assessed.
The foot pulses on the inner ankle and on the back of the foot are sensed. An increased temperature of the skin, induration, reddish skin changes or pressure-sensitive areas can be indications of superficial phlebitis.

The attending physician first checks the extent of the varicose veins on the standing and then on the lying patient and differentiates between primary and secondary varicose veins. The most important question is whether the deep leg veins are abnormally changed and whether there are significant accompanying diseases. Of course, other diseases that can cause similar symptoms should also be excluded. For example, fluid deposits in the legs or leg swelling can also indicate a weak heart, impaired kidney function, lymphedema, drug side effects, etc.

Tests and pressure measurement

Manual examination methods used to be of great importance for the diagnosis of venous diseases. In the meantime, however, such tests have taken a back seat due to modern and more reliable examination methods including new imaging methods. Phlebodynamometry, in which the pressure conditions in the external veins are measured using a cannula inserted into the foot, is also rarely used. In the case of judicial reports, however, this procedure can occasionally still be helpful.

Light reflection rheography (LRR) and vein occlusive plethysmography (VVP), on the other hand, are still common examination methods today, especially in the context of follow-up checks on severe venous diseases and before and after interventional procedures on the venous system.

Imaging procedures

• Duplex sonography with Doppler ultrasound probe
• venography
• Magnetic resonance phlebography
• Light reflection rheography (LRR)
• Vein occlusive plethsmography (VVP)

Duplex sonography with Doppler ultrasound probe

The color-coded duplex sonography with Doppler ultrasound probe is the method of choice for vein visualization today. With this non-invasive, painless and absolutely risk-free method, both the condition of the superficial venous system including the venous valves and changes in the deep venous system, including any recent or older deep thromboses, can be identified and documented. At the same time, the direction and speed of the blood flow in the superficial and deep veins can be measured. The only “disadvantage” of this method is that the examiner should have a correspondingly well-founded experience.


Phlebography is an X-ray examination of the leg veins in which a contrast agent is injected into the veins (usually on the back of the foot). This enables an overall view of the superficial and deep venous system. However, this procedure has also lost a lot of its importance and is now only used for very special issues.

Magnetic resonance phlebography

A modern alternative to this is the magnetic resonance examination (MRT) of the veins, i.e. imaging without X-rays, but with a contrast agent being injected through a vein in the arm. However, this method is only required in rare cases.

Light Reflection Rheography (LRR)

In light reflection rheography (LRR), an optical probe glued to the lower leg is used to examine the pumping work of the calf muscles and then the replenishment time of the blood in the veins and assess the functionality of the venous valves.

Vein occlusive plethysmography (VVP)

With this bloodless and safe method, both the arterial flow into the legs and the speed of the venous drainage - this is delayed in the case of deep thrombosis - can be assessed.

Laboratory examination

A medical laboratory analysis of individual blood coagulation factors can be important if, for example, a patient has suffered a deep vein thrombosis or even an embolism, the cause of which cannot be identified even after detailed questioning. A congenital or acquired coagulation disorder can then be detected in the laboratory. However, the attending physician should always assess very carefully beforehand whether such an examination is sensible and justifiable!