One must consider the venous system as a whole rather than as individual parts. The deep system of veins within the muscular compartments of the legs communicates with the superficial system of veins under the skin and fatty tissue (outside the muscles) through a network of communicating veins which act as bridges between the two systems. The deep system returns more than 95% of the venous blood from the legs to the pelvis, while the superficial system accounts for 5% or less. Since leakiness in the superficial veins is responsible for more than 95% of patients’ problems, ultrasound evaluation of the lower extremity venous systems is an integral part of their comprehensive venous workup. This evaluation will ensure that any underlying vein problems are identified, and, if necessary, corrected before treatment of the external signs of venous disease is initiated. For example, prior to removing bulging veins in the calf, it is important to first identify the underlying leaky vein and seal it, thereby decreasing the chance that other bulging veins will develop in the future.
As many as 35-40 million adults in the United States are affected by treatable, symptomatic, superficial venous insufficiency. Many of these patients, as well as their primary care or specialty physicians, may not be fully aware of the advances which have been made in the understanding and treatment of venous insufficiency since the introduction of endovenous ablation in 2000. Endovenous ablation or closure has supplanted, vein stripping as the preferred treatment of patients with symptoms related to saphenous vein and other superficial venous insufficiency. Many patients once thought to have untreatable venous problems may now be excellent candidates for endovenous closure.