Varicose veins, or the underlying condition known as chronic venous insufficiency, can exist without any visible bulging veins on the skin’s surface. This scenario, often called “hidden” or “occult” varicose veins, involves damage to the venous system that causes symptoms beneath the skin before any visible sign appears. The presence of these internal symptoms indicates a structural issue that warrants professional evaluation.
Understanding Venous Reflux
The true cause of both visible and hidden varicose veins is venous reflux, which is the backward flow of blood. Healthy leg veins rely on a series of small, one-way valves that allow blood to flow upward toward the heart and close to prevent backflow due to gravity. Chronic venous insufficiency develops when these valves become weakened or damaged and fail to close properly.
When the valves fail, blood leaks backward and pools, causing pressure to build up inside the vein. This pressure is contained within deeper veins, such as the Great Saphenous Vein (GSV). This internal pressure causes the vein to stretch and enlarge, leading to systemic symptoms even without visible surface varicosities.
Recognizing the Signs
Since the problem is internal, the first indicators of hidden venous disease are subjective sensations felt in the legs. A common complaint is a feeling of heaviness or fatigue that worsens throughout the day, especially after prolonged standing or sitting. This sensation is directly related to the elevated pressure and pooling of blood in the lower limbs.
Individuals often experience a dull, persistent aching or throbbing that is relieved by elevating the legs. Other frequent symptoms include unexplained cramping, particularly at night, and a persistent urge to move the legs, often described as restless legs syndrome. Localized swelling, or edema, around the ankles and lower calves, which is more noticeable toward the evening, can also signal underlying venous reflux.
How Hidden Varicose Veins Are Diagnosed
Because visual inspection is insufficient, a specialized imaging test is required to assess underlying venous health. The standard diagnostic tool is a Duplex Ultrasound, a non-invasive procedure that uses sound waves to visualize the veins beneath the skin. This technology combines traditional ultrasound imaging of the vein’s structure with Doppler technology, which measures the speed and direction of blood flow.
During the test, a technician maps the entire venous system and checks for the telltale backward flow of blood that indicates valve failure and reflux. This allows for precise identification of damaged veins, such as the saphenous trunk, and measures the severity of the reflux. The ultrasound provides the specific structural and functional information necessary to confirm a diagnosis of chronic venous insufficiency.
Management and Treatment Options
Once non-visible venous disease is confirmed, management begins with conservative measures designed to improve blood flow and reduce pressure. Lifestyle adjustments are a primary focus, including regular physical activity to activate the calf muscle pump and elevating the legs several times a day to encourage venous return. The most common intervention is the daily use of graduated compression stockings, which apply external pressure to the leg, helping the valves function more effectively and preventing blood from pooling.
Minimally Invasive Procedures
For cases where conservative methods are insufficient to relieve symptoms, minimally invasive procedures can be performed to address the faulty vein directly.
- Endovenous Laser Ablation (EVLA) or Radiofrequency Ablation (RFA) use heat energy delivered via a thin catheter to close the damaged vein from the inside.
- Sclerotherapy involves injecting a chemical solution into the vein to cause it to scar and seal shut.
These treatments reroute blood flow to healthy veins, resolving the underlying reflux and alleviating the associated symptoms.