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Medical Testing for Varicose Veins and Spider Veins

Diagnostic studies are an essential part of the proper work-up when evaluating and treating venous disease. You can only determine so much from a physical exam. The doctor needs to determine if the deep veins are working well. He also needs to map out the extent of the varicose veins and determine which vein pathways are not working and which ones are working. Some of the questions that must be answered are:

  • Is there any evidence of current blood clots (deep vein thrombosis)?
  • Is there any evidence of old blood clots?
  • Does the patient have good alternative sources of circulation before the varicose veins are permanently removed? Are the deep veins, the deep femoral and superficial femoral, functioning properly or are they incompetent (leaking) as well?
  • Is the Greater Saphenous Vein (GSV) working well or is it responsible for much of the superficial vein disease? Is the Sapheno-femoral junction competent or not working?


Ultrasound of LegAny trained, experienced vein specialist will always perform vein testing first before treating your varicose veins, and most of the time even if you have only superficial cosmetic spider veins. YOU SHOULD NEVER HAVE VARICOSE VEINS TREATED BEFORE AN EVALUATION WITH DUPLEX ULTRASOUND.


In our practice, we have found that almost one third of the patients that presented with even very superficial cosmetic spider veins actually had other venous circulatory problems that would have been missed without proper testing.


Non-Invasive diagnostic tests for varicose veins and spider veins are painless and are perfectly safe. There are no scalpels, needles, or medications involved. Your tests will take about 30-45 minutes from start to finish.Here's what to expect:

Color-flow Duplex Ultrasound Exam

This is the most sophisticated technique in testing technology for evaluating anatomy and leakage in varicose veins. It is available only in highly specialized vein centers. Sound waves are used to make an actual "picture" or "road-map" of deeper veins that cannot be seen from the surface. An ultrasonic probe will be placed on the surface of your skin to produce a color display of your vessels. The actual picture of your veins and the blood flow will be displayed on a TV-like screen. The test determines if your veins are open, the presence and direction of blood flow, and identifies any vein blockage or narrowing. Vein mapping is important whenever the problem is more than skin deep.

Duplex Ultrasound To Determine Vein Disease and Reflux

Bi-directional Doppler Ultrasound Exam

Sound waves will be bounced off the blood moving within your blood vessels, and the returning sound will show how fast the blood is moving, what direction it is going, and whether it pauses during normal breathing. An augmentation test or gentle hand squeezing of the leg will show whether the valves in your leg veins are working correctly. Bad vein valves leads to varicose veins.


Special electronic equipment with a small light-emitting diode and a receiver will be attached to your ankle with Scotch tape. You will be seated comfortably and stay stationary for a few minutes to allow for the blood in your leg to pool inside your foot. Then you will be asked to lift your toes off the floor ten times in a row. As you pump the blood out of your foot the change in light absorption will show how well your 'calf muscle pump' is pushing blood out of the lower leg, and how long it takes for the calf veins to refill with blood after being emptied. Any obstruction to the blood flow, such as a blood clot, will be demonstrated on the graph readout as a decrease in the amount of blood pumped out of your lower leg.

Illustration of Photoplethysmography for Deep Venous Thrombosis


You will be asked to lie on your back with your legs supported higher than your heart. A pressure cuff (just like the one used to take your blood pressure) will be placed around your calf, and another one will be attached to your thigh. The pressure in the calf is measured while the thigh cuff is slowly inflated and then deflated. The pressure in the calf will not change as much nor as quickly if the veins are blocked in any way.