The mechanism, plainly
Blood in the legs has to travel upward against gravity to get back to the heart. Two things make that possible: the calf muscles, which squeeze the deep veins every time you take a step, and a series of one-way valves inside the veins that stop the blood sliding back down between steps.
Venous reflux disease — also called venous insufficiency or valvular incompetence — is the failure of those valves. When one no longer closes, blood falls back down through it and collects in the vein below. That vein now carries more blood at higher pressure than it was built for, and passes the problem downward.
Why it is the diagnosis that matters
Almost everything a vein practice sees is downstream of reflux. Varicose veins are the stretched vessels. Spider veins are often the surface overflow. Leg swelling, skin staining and venous ulcers are what sustained pressure does to tissue over years.
Treat any of those without finding the reflux and you are treating a symptom that is still being fed. It is why spider veins are injected and return, and why a vein removed at one point on the leg is replaced by another nearby. Finding which valve failed, and where, is what turns a series of treatments into one treatment.
How it is found
A duplex ultrasound examination, done standing. It combines a picture of the vein with a measurement of which way and how fast the blood inside it is moving. The examiner compresses the calf, releases, and watches: in a competent vein the valve shuts and the flow stops; in an incompetent one the blood falls back down, and the duration of that backflow is measured.
The result is a map — which segments are refluxing, how long they reflux for, where the incompetence starts and where it stops. That map determines whether treatment is needed at all, which vein, and by which method. No treatment is recommended here without it.
Treating it
The refluxing vein is closed and taken out of circulation:
- Radiofrequency ablation for the long, straight, larger veins — a catheter under local anaesthetic delivers controlled heat along the vein wall, sealing it.
- Varithena® microfoam where the vein is tortuous, branched or awkwardly placed, which a catheter handles badly and foam handles well.
- Sclerotherapy for the remaining surface branches once the source is dealt with.
All are office-based, and you walk out the same day. Compression stockings and daily walking do the rest of the work over the following weeks.
What to expect
The symptoms that come from pressure — heaviness, aching, evening swelling — usually improve quickly, because the pressure is what has just changed. Appearance follows more slowly. Skin changes that have been present for years improve partially at best, which is an argument for being seen while the complaint is still “my legs get tired”, not after the skin has broken down.
