Our physicians considers the venous system as a whole rather than as individual parts. The deep system of veins in the muscular compartments of the legs communicates with the superficial system of veins in the skin and fatty tissue, through a network of communicating or perforating veins which act as bridges between the two systems. Most patients who present with anything more than small spider veins in the thighs will undergo ultrasound evaluation of their lower extremity venous system as part of their comprehensive venous workup.
Ultrasound evaluation is the critical examination in the diagnosis of venous insufficiency and will ensure that any underlying vein problems are identified and, if needed, corrected before treatment of the external signs of venous disease is initiated.
For example, rather than rushing to inject extensive calf spider veins in a patient with significant calf edema and spiders, an ultrasound of the affected extremity might be a good first step. Similarly, prior to removing bulging veins in the thigh or calf, it is important to first identify the underlying leaking vein and seal it, thus reducing the chance that other bulging veins may develop in the future.