Varicose veins on the backs of thighs is a classic presentation of pelvic vein reflux.
These varicose veins brand diagonally from the buttock area to the outside of the thigh. Often they are tender, particularly at the time of the period.
Many times, patients also have varicose veins around the buttocks, perineum or vulva/vagina.
This patient came to The Whiteley Clinic because she had had two previous operations elsewhere to try and fix her veins. Neither had worked and so she decided to come to get an expert assessment. These veins get particularly tender at the time of her period.
The first doctor had tried to put the veins out using a process called phlebectomy. The second had used ultrasound guided foam sclerotherapy. Of course neither had worked.
The reason they had not worked is that the doctors had not realised that these veins are actually coming from pelvic varicose veins. Pelvic varicose veins is due to pelvic venous reflux.
The only way that these varicose veins will ever be treated properly, is to identify the cause in the pelvis and to treat that first.
The gold standard test for finding the varicose veins in the pelvis is the transvaginal duplex scan performed by the Holdstock technique. Research has shown the MRI, CT or venogram there is not appear to be as sensitive as this simple ultrasound test developed by the experts at The Whiteley Clinic. This is because they use the size of the vein – not the flow in it – and size of the vein has been shown to be useless. (see: https://www.ncbi.nlm.nih.gov/pubmed/25457295)
This patient will have a transvaginal venous duplex ultrasound scan followed by pelvic vein embolisation of the appropriate pelvic veins as identified by that test.
Once the reflux from the pelvic veins has been stopped, we will then be able to treat her leg varicose veins with the lowest possible risk of them ever returning.
Failure to recognise pelvic vein reflux is one of the major reasons why most doctors are not able to get the same low recurrence rates that we find in our patients when we audit our results at The Whiteley Clinic, using The Whiteley Protocol to assess and treat patients.