Management of varicose veins: Status of clinical examination and Colour Doppler in the present Indian scenario

Varicose veins affect a significant percentage (40%) of the middle-aged population. It may not cause any mortality in the patients but causes a significant morbidity if left untreated. It is important to properly localize the problem before surgical management, to avoid recurrence of the disease. Clinical examination, if done alone for evaluation of patients of varicose veins, has a sensitivity of 90% for the saphenofemoral junction. But for perforator incompetence, it has a sensitivity of 61.5% only. There are likely chances that incompetent perforators are missed and may lead to recurrence of disease. Colour duplex ultrasound is an important non-invasive method for identification of superficial venous and perforator incompetence. It is especially valuable in detecting saphenopopliteal and perforator incompetence where accuracy of clinical examination is very low. It can help in localizing the perforators more precisely so that surgery can be performed by small incisions, especially at places where the facility for subfascial endoscopic surgery (SEPS) is not available. The authors recommend Color Doppler sonography in all patients of varicose veins before subjecting them to surgery as it is available in most of the district level centres in India.