Recently I had a question from a patient who had had a duplex ultrasound scan elsewhere
and she had been told that she had reflux and floppy valves and she wanted to know whether
this was really the cause of her varicose veins and thread veins.
The function of veins is to carry blood upwards from the legs back to the heart and gravity
is always trying to pull the blood downwards in the wrong direction.
Now whenever anything travels in the wrong direction in the body we call it reflux.
Some of you might be familiar with acid reflux.
That is a condition in which acid comes up in the wrong direction instead of going downwards
to digest your food.
Well similarly if blood is coming downwards in the wrong direction under the pull of gravity
towards the legs we call it vein reflux or to give it its full title superficial vein
reflux.
Now inside the lining of the vein there are delicate folds that come together and shut
tight preventing blood from coming down in the wrong direction.
If these valves do not meet properly if they are floppy or if the vein is very large and
the valves cannot meet then gravity can indeed pull the blood down in the wrong direction
and that can cause distension and the appearance of varicose veins or even thread veins.
Here we can see a duplex ultrasound scan.
At the top is skin and lower down is the muscle layer.
The veins appear as circles because they are in cross-section as if we are going into a
tunnel towards feet.
Now here you can see a fold in the lining a valve which is meeting correctly.
When I squeeze the patient's leg forcing blood upwards we can see the valve opening.
And when I let go and when gravity tries to pull the blood back down in the wrong direction
the valve shuts tight.
Here is an example of a valve which is not working properly.
It is indeed floppy.
It is not meeting properly and it is not doing its job of resisting the flow of blood downwards.
And in this situation there is indeed superficial vein reflux.
Now on a duplex ultrasound scan a blue signal indicates blood going upwards from the leg
to the heart in the right direction.
And when I squeeze the leg we see a blue signal.
When I let go of the leg the valves should meet properly and there shouldn't be any colour
at all - or only just a very brief flash of red.
However if the valves are floppy and if there is superficial vein reflux the valves do not
meet and when I let go we see a red signal as in this situation.
So in answer to your question "yes floppy valves cause superficial vein reflux and superficial
vein reflux causes varicose veins and thread veins.
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