Varicose veins are diagnosed by consideration of symptoms (when present) in combination with a physical examination to identify the presence, location, and severity of varicose veins. The exam may be done in a standing position to better assess venous dilation, and often includes checking pulses and looking for skin changes. In some cases (especially symptomatic ones), an imaging test called a duplex venous ultrasound may be completed to more closely evaluate the veins. An ultrasound can determine how well blood is flowing through the veins and where there may be improperly working valves that are causing blood to flow backwards (called venous reflux). This test is painless and noninvasive. Varicose veins are clinically classified using the class, etiology, anatomy, and pathophysiology (CEAP) system, which ranks the presence and severity of chronic venous disorders on a continuum from no venous disease to active venous ulcers.[1]
