When it is varicose veins?

 I came across a lady not so long ago who wouldn't take her children swimming because she felt so embarrassed about the sight of her legs, and the distress that some of these unsightly veins cause can be quite severe.  I say 'even' thread veins we now know that thread veins and spider veins are associated with this condition called reflux, so it's not surprising that even thread veins cause symptoms or are associated with symptoms. 

Until we knew a little bit more about the condition we didn't really, as doctors, believe people who say "well my thread veins hurt and they burn and they itch" but they do, and we now know that if you treat thread veins properly the majority of people get relief of their symptoms as well. So, as I say, a frequent question is "I've got bad varicose veins, will I get a problem". Well, the majority don't but if you do get medical problems they come under one of these four headings.  As I say, the majority will not. The first one I'd like to talk about is phlebitis. 

A frequent question is "I've got phlebitis,what is it and will it cause me any harm?".  Another condition is varicose eczema, a condition of the skin caused by reflux and these other conditions, deep vein thrombosis, bleeding and ulcers.  Let's talk about those very briefly in turn. Now phlebitis is often a misused term, both by the public and by doctors.  The strict medical definition of phlebitis is an inflammation in the vein, that's all it means really, doctors add the word 'itis' on the end of the word to indicate inflammation. 

I think 'phleb' is a Greek or Latin word that means vein and 'itis' means inflammation, so it's an inflammation of the vein.  It appears clinically, that is on the surface, as a hard, tender lump underneath the skin, so it's quite superficial phlebitis involves the superficial veins, it's superficial and it has all the features of inflammation, so if you've ever had inflammation elsewhere you'll know that it's red, warm, tender and it's quite a severe condition.  These people often can't go to work it's that painful, and it used to be thought to be quite a trivial condition so if you went to see your doctor he'd say "oh that's just a bit of phlebitis,take some painkillers and go away". We now know, however, that to diagnose phlebitis correctly, you should have an ultrasound scan.

People who are diagnosed as having phlebitis are often misdiagnosed, and when you look with an ultrasound scan there's another condition, so having an ultrasound firstly confirms that it is phlebitis because you can actually look at the superficial vein and the appearance on ultrasound is quite characteristic of the condition and you can make sure there's nothing else amiss, because we now know that phlebitis is frequently associated with deep vein thrombosis.

The clot that occurs inside these veins can extend further and into the deep veins and that can be quite a significant problem, quite a severe condition. Last week I saw a patient in Bristol who had been treated by his doctor with phlebitis and in fact he had a deep vein thrombosis all along so the diagnosis was wrong it would have been established with an ultrasound scan and he had quite a significant deep vein thrombosis that put him at risk. 

So phlebitis is not a trivial condition, it should now have an ultrasound scan, that's the recommendation of two very influential bodies, one in the United Kingdom and one in America, and that recommendation came out last year that all people with phlebitis should have an ultrasound scan.