Editing Varicose veins (section)

== Diagnosis ==

=== Clinical test ===
Clinical tests that may be used include:{{citation needed|date=February 2021}}
* [[Trendelenburg test]] – to determine the site of venous reflux and the nature of the saphenofemoral junction

=== Investigations ===
{{See|Ultrasonography of chronic insufficiency of the legs}}
Traditionally, varicose veins were investigated using imaging techniques only if there was a suspicion of deep venous insufficiency, if they were recurrent, or if they involved the saphenopopliteal junction. This practice is now less widely accepted. People with varicose veins should now be investigated using [[Ultrasonography of chronic insufficiency of the legs|lower limbs venous ultrasonography]]. The results from a [[randomised controlled trial]] on patients with and without routine ultrasound have shown a significant difference in recurrence rate and reoperation rate at 2 and 7 years of follow-up.<ref>{{cite journal | vauthors = Blomgren L, Johansson G, Emanuelsson L, Dahlberg-Åkerman A, Thermaenius P, Bergqvist D | title = Late follow-up of a randomized trial of routine duplex imaging before varicose vein surgery | journal = The British Journal of Surgery | volume = 98 | issue = 8 | pages = 1112–1116 | date = August 2011 | pmid = 21618499 | doi = 10.1002/bjs.7579 | doi-access = free }}</ref>

=== Stages ===
The CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) Classification, developed in 1994 by an international ad hoc committee of the [[American Venous Forum (AVF)|American Venous Forum]], outlines these stages<ref name="pmid24868066">{{cite journal | vauthors = O'Flynn N, Vaughan M, Kelley K | title = Diagnosis and management of varicose veins in the legs: NICE guideline | journal = The British Journal of General Practice | volume = 64 | issue = 623 | pages = 314–315 | date = June 2014 | pmid = 24868066 | pmc = 4032011 | doi = 10.3399/bjgp14X680329 }}</ref><ref name="pmid15622385">{{cite journal | vauthors = Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, Meissner MH, Moneta GL, Myers K, Padberg FT, Perrin M, Ruckley CV, Smith PC, Wakefield TW | display-authors = 6 | title = Revision of the CEAP classification for chronic venous disorders: consensus statement | journal = Journal of Vascular Surgery | volume = 40 | issue = 6 | pages = 1248–1252 | date = December 2004 | pmid = 15622385 | doi = 10.1016/j.jvs.2004.09.027 | doi-access = free }}</ref>

* C0 – [[Perthes test]] – no visible or palpable signs of venous disease
* C1 – [[telangectasia]] or reticular veins
* C2 – varicose veins
* C2r – recurrent varicose veins
* C3 – edema
* C4 – changes in skin and subcutaneous tissue due to Chronic Venous Disease
* C4a – pigmentation or eczema
* C4b – [[lipodermatosclerosis]] or atrophie blanche
* C4c – Corona phlebectatica
* C5 – healed venous ulcer
* C6 – active venous ulcer
* C6r – recurrent active ulcer

Each clinical class is further characterized by a subscript depending upon whether the patient is symptomatic (S) or asymptomatic (A), e.g. C2S.<ref name="Bailey&Love">{{Cite book | veditors = Williams NS, Bulstrode CJ, O'Connell PR, Bailey H, McNeill Love RJ |title=Bailey & Love's Short Practice of Surgery |edition=26th | date = 2013 | location = London | publisher = Hodder Arnold | isbn = 978-1-4441-2127-8 }}</ref>