I have superficial and deep vein reflux in both legs. Would I benefit from treatment?

Ultrasound shows I have superficial and deep vein reflux in both legs. I am very symptomatic (heavy and achy legs) and manage this with compression stockings, elevation and exercise. Here is the greatest # on my ultrasound report: left GSV ( SFJ): 3200 ms, right SSV - mid calf: 6488 ms, common femoral vein 1168 ms on the right and 1248 on the left. Doctors do recommend procedures, but I feel I might not benefit from them. Can both the superficial and deep reflux be resolved with treatment?

Answers from doctors (6)


Vein Specialty Medical Clinic, Inc.

Published on Oct 13, 2016

Thanks for the question. I looked at the reflux time in your US report, as you stated. In regards to the numbers for deep veins, your reflux time is very borderline and I am not convinced that you really have deep vein disease. If you have had deep vein thrombosis at the upper thigh or groin level in the past, that is a very important piece of data which should be considered. I doubt if you had this condition, otherwise you would have stated it. About US studies, in the 25 years, that I am practicing phlebology and train physicians, through asking patients who come to me for a second opinion, about 90% of patients who had ultrasound to study for possible legs venous reflux, their studies where done with the patient lying down on the exam table! That is a huge mistake and actually ignorance on part of the sonographer. All official guidelines for such study, clearly state that this study must be done with the patient in standing position. Slight elevation of upper part of the patient (trunk) of even reverse trendelenburg position are all incorrect when studying for superficial veins (including saphenous veins & perforating veins) to look for reflux. You can refer to American College of Phlebology Guidlines in the matter at www.phlebology.org The only acceptable time when resverse trendelenburg posotioning can be used, is to study deep veins only (not saphenous veins or studying perforating veins reflux, which are very common sources of reflux in cases of varicose veins of legs. So, if a patient gets study of varicose veins done when he/orshe is positioned in lying down on the table, you can strongly doubt if you are in a right place to have your varicose veins treated correctly! US/Duplex scan lays down the foundation for correct treatment planning for varicose veins. If this foundation is started incorrectly, most likely everything that follows will be wrong! Please share this fact with other patients.

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Answered by Vein Specialty Medical Clinic, Inc.

Thanks for the question. I looked at the reflux time in your US report, as you stated. In regards to the numbers for deep veins, your reflux time is very borderline and I am not convinced that you really have deep vein disease. If you have had deep vein thrombosis at the upper thigh or groin level in the past, that is a very important piece of data which should be considered. I doubt if you had this condition, otherwise you would have stated it. About US studies, in the 25 years, that I am practicing phlebology and train physicians, through asking patients who come to me for a second opinion, about 90% of patients who had ultrasound to study for possible legs venous reflux, their studies where done with the patient lying down on the exam table! That is a huge mistake and actually ignorance on part of the sonographer. All official guidelines for such study, clearly state that this study must be done with the patient in standing position. Slight elevation of upper part of the patient (trunk) of even reverse trendelenburg position are all incorrect when studying for superficial veins (including saphenous veins & perforating veins) to look for reflux. You can refer to American College of Phlebology Guidlines in the matter at www.phlebology.org The only acceptable time when resverse trendelenburg posotioning can be used, is to study deep veins only (not saphenous veins or studying perforating veins reflux, which are very common sources of reflux in cases of varicose veins of legs. So, if a patient gets study of varicose veins done when he/orshe is positioned in lying down on the table, you can strongly doubt if you are in a right place to have your varicose veins treated correctly! US/Duplex scan lays down the foundation for correct treatment planning for varicose veins. If this foundation is started incorrectly, most likely everything that follows will be wrong! Please share this fact with other patients.

Published on Jul 11, 2012


Vascular Center and Vein Clinic of Southern Indiana

Published on Oct 12, 2016

Superficial venous insufficiency is routinely treated with saphenous ablation in the office. Patients should expect improved symptoms with respect to swelling and throbbing.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1196_1551115459.jpg
Answered by Vascular Center and Vein Clinic of Southern Indiana

Superficial venous insufficiency is routinely treated with saphenous ablation in the office. Patients should expect improved symptoms with respect to swelling and throbbing.

Published on Jul 11, 2012


Center for Interventional Medicine, LLC

Published on Oct 12, 2016

In my professional experience, patients benefit from having the superficial venous reflux corrected, even when they have deep vein reflux. We tell our patients that they will at least see partial improvement (it might not be 100% improvement because of the persistent deep vein reflux). Also, some studies have suggested that correcting the superficial vein reflux may actually secondarily improve the deep vein reflux.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/8206_1473967293.jpg
Answered by Center for Interventional Medicine, LLC

In my professional experience, patients benefit from having the superficial venous reflux corrected, even when they have deep vein reflux. We tell our patients that they will at least see partial improvement (it might not be 100% improvement because of the persistent deep vein reflux). Also, some studies have suggested that correcting the superficial vein reflux may actually secondarily improve the deep vein reflux.

Published on Jul 11, 2012


Center for Interventional Medicine, LLC

Published on Oct 12, 2016

In my professional experience, patients benefit from having the superficial venous reflux corrected, even when they have deep vein reflux. We tell our patients that they will at least see partial improvement (it might not be 100% improvement because of the persistent deep vein reflux). Also, some studies have suggested that correcting the superficial vein reflux may actually secondarily improve the deep vein reflux.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/8205_1473967307.jpg
Answered by Center for Interventional Medicine, LLC

In my professional experience, patients benefit from having the superficial venous reflux corrected, even when they have deep vein reflux. We tell our patients that they will at least see partial improvement (it might not be 100% improvement because of the persistent deep vein reflux). Also, some studies have suggested that correcting the superficial vein reflux may actually secondarily improve the deep vein reflux.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Oct 12, 2016

If you are symptomatic of venous disease and have reflux, then you are a candidate for treatment. The superficial system is treated by a closure procedure and the deep system is treated by exercise, support hose, weight control and elevation as you are already doing.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1053_1499982262.jpg
Answered by Vanish Vein and Laser Center

If you are symptomatic of venous disease and have reflux, then you are a candidate for treatment. The superficial system is treated by a closure procedure and the deep system is treated by exercise, support hose, weight control and elevation as you are already doing.

Published on Jul 11, 2012


Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

Published on Oct 12, 2016

Deep venous reflux at the level of the groin is not treated, unlike reflux in the iliac veins where novel experimental treatments have shown some promise.

However, what is known is that treating superficial venous reflux disease somehow improves deep venous insufficiency--the reason for this is not known.

The outcome, in terms of deep venous insufficiency, cannot be predicted but it is worthwhile for you to get the superficial venous reflux treated.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/7743_1538076833.jpg
Answered by Hratch Karamanoukian, MD, FACS, RVT, RPVI, RPhS

Deep venous reflux at the level of the groin is not treated, unlike reflux in the iliac veins where novel experimental treatments have shown some promise.

However, what is known is that treating superficial venous reflux disease somehow improves deep venous insufficiency--the reason for this is not known.

The outcome, in terms of deep venous insufficiency, cannot be predicted but it is worthwhile for you to get the superficial venous reflux treated.

Published on Jul 11, 2012


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