Today, for the patient with varicose veins or venous vascular problems, a simple specialist visit is no longer sufficient, although accompanied by a color doppler echo that testifies to the insufficiency of the saphenous vein or other veins of the lower limb.

Prof. Casoni explains how the so-called “phlebological visit” actually, in modern and qualified environments, has evolved into a “diagnostic-therapeutic path” which involves a series of clinical-instrumental steps aimed at achieving a very precise diagnosis and consequently the ” setting up an adequate therapeutic protocol.

“In the first instance – says Prof. Casoni – a clinical evaluation of the state of the skin of the legs and of the peripheral arterial vascular condition is carried out by measuring the pressure index with pulsed doppler together with oxygen saturation with a simple oximeter.

Subsequently, an ultrasound examination of the superficial and deep venous system is carried out (in 35% of cases there are in fact anatomical anomalies of the venous system that must be framed and classified), simultaneously the arterial endothelial thicknesses are measured to define a “biological age” of the circulatory system, mirror of the real biological age of the subject.

We proceed with a hemodynamic study, known as Echo color Doppler or Duplex, an examination aimed at measuring the flows towards the heart and from the heart to the periphery (refluxes), establishing their entity, volume and anatomical site. In this way a hemodynamic map of the single limb is constructed to then decide the best therapeutic strategy with the following steps.

The ultrasound examination and color Doppler echo are not limited to the evaluation of the arterial and venous vascular system only, but also to the evaluation of the thyroid gland, often unexpectedly involved in problems of venous stasis and / or phlebolymphedema.

Two other important pieces of information remain to be known: the strength of the venous drainage muscle pump, and the actual “capacitance” of the venous vascular bed, that is, how much the venous walls are exhausted and how long the venous park fills up after being emptied by suitable exercises by activating the muscle pumps.

This is the Photoplethysmography, recently introduced at the Vein Clinic Ippocrate ”.