Hidden Varicose Veins Missed for 10 Years

Swollen Left Ankle for 10 Years

A lady in her 70’s came to see us at The Whiteley Clinic for a second opinion. She had been suffering with a very swollen left ankle for over 10 years. Her right ankle was somewhat swollen – but not as bad as the left.

Swollen left ankle due to hidden varicose veins missed for 10 Years

A lady in her 70’s came to see us at The Whiteley Clinic for a second opinion. She had been suffering with a very swollen left ankle for over 10 years. Her right ankle was somewhat swollen – but not as bad as the left.

She had been told that she had lymphoedema. She had been treated for 10 years in a specialist lymphoedema unit without much improvement.

In the past she had seen a vascular surgeon to have her veins checked. Unfortunately she had a quick scan taking only 5-10 minutes, performed by the surgeon themselves rather than an in-depth venous scan performed by a venous specialist vascular technologist working within a specialist venous service. She had been told that her veins were all normal.

Over the years, the lymphoedema treatments had not improved her. She started to notice that her left ankle had become somewhat discoloured.

Hidden Varicose Veins Found by The Whiteley Clinic

Having seen some articles about the research led investigations and treatments at The whiteley Clinic, this lady decided to come for a second opinion. An initial consultation showed the swelling and discolouration, but no visible varicose veins.

The first test that was performed was a Photoplethysmography (PPG) that showed there was severe venous malfunction in the veins.

Photoplethysmography (PPG) showing venous reflux for hidden varicose veins

This was followed by a specialist venous duplex ultrasound scan performed by a The Whiteley Clinic trained vascular technologist and taking over 45 minutes. This scan showed huge hidden varicose veins as a major underlying cause for the swelling.

On the left side, the Small Saphenous Vein (SSV) was completely incompetent and was a very large 8mm in diameter. On the right hand side she had moderate reflux in the veins affecting both the Great Saphenous and Small Saphenous veins, and one incompetent perforator vein.

Hidden Varicose Veins v Varicose Veins

Varicose veins bulge on the legs on standing or sitting with the legs down. They are caused by the valves not working inside the leg veins allowing blood to pool in the veins themselves. Varicose veins affect about 15 – 20 of every hundred adults.

When the legs veins lose their valves but the veins cannot be seen to bulge on the surface, the blood still pools in the leg veins and can cause damage leading to swelling, skin damage or even leg ulcers over time. If the varicose veins cannot be seen on the surface, then the condition can be called a variety of names: SVR (superficial venous reflux), CVI (chronic venous incompetence), SVI (superficial venous incompetence) etc.

However the large number of such terms led to confusion and so in 2009, Mark Whiteley introduced the term “Hidden Varicose Veins” which he presented in his book “Understanding Venous Reflux – The Cause of Varicose Veins and Venous Leg Ulcers” in 2011.

Interestingly, 15 – 20 of every 100 adults have hidden varicose veins. This means that for every person that knows that they have varicose veins, there is another person with venous reflux who is at risk of all of the complications of venous reflux, who does not know that they have the problem.

This lady is a prime example of this. Had she been diagnosed with hidden varicose veins any time in the past, she could have been treated and the swelling improved or even cured – and she might have saved considerable time and money spent on lymphoedema clinics and appliances.

Swollen left ankle CEAP 3 due to hidden varicose veins missed for 10 Years

Treatment

These hidden varicose veins are easly treated by endovenous laser therapy (EVLT) undr local anaesthetic as a walk-in walk-out case. This is being planned for later in the summer.

Hidden Varicose Veins needs Duplex Ultrasound Scanning

The simple lessons from this case are:

• If you have any ankle swelling, skin changes (red, brown or harder shiny areas) in the lower leg, aching or itching leg or leg ulcers, you must have a venous duplex ultrasound scan performed by a specialist working within a specialist clinic (not a quick scan performed by an enthusiast working by themselves)
• Never let any doctor, nurse or health professional tell you that there is nothing wrong with your veins, unless you have had a proper in-depth venous duplex scan to confirm it.