One of the most common questions I hear from patients in Dr.Smile Vein Centers is, “Why do different doctors give such different advice for treating varicose veins?” Some recommend surgery, while others suggest conservative management. From my experience, one major reason for these differences lies in whether or not a hemodynamic assessment has been performed.
Varicose veins may appear to be just bulging, twisted veins on the surface, but the root problem runs much deeper—literally. The condition stems from abnormal blood flow within the veins, where valves meant to keep blood moving upward toward the heart fail. This valve dysfunction causes blood to flow backward (known as reflux), creating pressure that leads to vein dilation. However, not all varicose veins are the same. The paths of reflux and the severity of the condition vary significantly between patients. Without a proper hemodynamic assessment, doctors are left to rely on visual cues and symptoms alone, which can lead to widely differing opinions on treatment.
I often tell patients that varicose veins aren’t “one disease” but rather a collection of different conditions. The pathways of abnormal blood flow, also known as SHUNTS, are the key to determining the right approach. For instance:
- In some patients, blood flows from deep veins to superficial veins through perforating veins. In these cases, the focus should be on closing the abnormal perforating vein.
- For others, the problem lies at the saphenofemoral junction, where the great saphenous vein meets the deep venous system, and this area needs to be treated.
With a detailed hemodynamic assessment, we can pinpoint the exact type and location of the reflux. This enables us to choose the most effective treatment method. For example, CHIVA (Conservative Hemodynamic Cure of Venous Insufficiency) is a minimally invasive technique that targets reflux pathways while preserving healthy veins. Unlike traditional vein stripping, which removes the entire vein, CHIVA selectively addresses the abnormal pathways to restore proper blood flow with minimal disruption. However, without a proper assessment, such targeted interventions are impossible.
I’ve seen patients who have undergone surgeries for varicose veins, only to experience recurrence a year or two later. Upon closer examination, it often turns out that their previous treatments didn’t address the underlying reflux pathways—such as untreated perforator veins or missed SHUNTS. These issues could have been identified with a thorough hemodynamic evaluation.
Admittedly, performing detailed assessments can be challenging in some settings. Not every clinic is equipped with advanced duplex ultrasound machines, and interpreting the results requires specialized expertise. Sometimes, when a patient’s symptoms are mild, doctors might skip the evaluation altogether and recommend conservative measures. While this approach may work in certain cases, it risks overlooking potential progression or missing an opportunity for early, minimally invasive intervention.
To me, treating varicose veins is a “customized” process, not a “one-size-fits-all” solution. Each patient’s veins have a unique anatomy and pattern of dysfunction. By using hemodynamic assessments, we can craft personalized treatment plans that address the root cause of the problem. I encourage patients to ask their doctors questions like, “Has my blood flow been assessed? Do you know where the problem originates?”
Ultimately, our goal isn’t just to eliminate the visible, bulging veins that bother patients. It’s about restoring normal blood flow and ensuring that your legs feel lighter, healthier, and free from the complications that vein dysfunction can bring.
So, the next time you’re considering treatment for varicose veins, remember: it’s not just about what you see on the surface. Understanding what’s happening beneath is the real key to long-lasting relief.
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