Ultrasound learners find it tricky to tell varicose veins from the great saphenous vein (GSV) and the small saphenous vein (SSV). In this video, you'll learn you'll learn how identify varicose veins with confidence and what to do if you find a blood clot in a varicose vein.
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A tricky part of insufficiency studies is differentiating the great and small saphenous veins from nearby varicose veins. Varicose veins usually stem from the GSV, SSV or perforators. Varices can be seen traveling even more superficially than either the GSV or SSV. On this image, you can see how the superficial varicose veins appear at the top of the screen above the GSV and Cleopatra's eye.
Varicose veins are often dilated and tortuous. In ultrasound, this is an easy, important way to distinguish varices from the GSV and SSV because tortuous varicose veins often travel through both longitudinal and transverse planes and display as a cluster of lines and/or black circles. This is because their twisty path is not being viewed from both planes at the same time. That would require 3D imaging capabilities, which are up and coming. In this video, note the tortuous varicose veins in the superficial tissue.
This tortuosity can help distinguish varices from the GSV and SSV. Varicose veins grow to handle extra blood pressure and refluxing leg veins. As they are created and grow, varicose veins do not develop valves. Therefore, all varicose veins have reflux and so they do not need to be tested with augmentation. Varicose veins and the GSV and SSV can develop clots and should be tested with compression, especially in focal areas of pain, warmth or redness. Clot within a varicose vein may be clinically relevant, though not regularly treated because of its low risk of connecting with the deep system and therefore low potential to cause a pulmonary embolus. A warm compress on the area is often recommended. Here, you can see an example of a clot in a varicose vein resulting in the vein only being partially compressible.