Central Vein Compression Needs Treatment Before Leg Veins Can Heal

Patient: Male, 34 years old

Background:
Antonio has been dealing with recurring varicose veins, mostly on his left thigh. He previously had treatment on the main vein in his left leg (great saphenous vein). He also had surgery for varicocele (enlarged veins in the scrotum), which is similar to pelvic varicose veins and is a sign of increased pressure in the pelvic veins.

Symptoms and Examination:
Upon examination, Antonio has large, bulging veins starting in his groin area and running down the front and inner part of his left thigh. These vein clusters suggest that pressure is building up, coming from deeper within the body, not just from problems in the smaller veins lower down. He has a very large and swollen vein called the anterior accessory saphenous vein in the upper thigh, which shows severe valve failure allowing blood to flow backwards for a long time.

Testing Results:
Ultrasound on the left leg showed:

• The very large swollen vein measuring 20.3 mm with reflux lasting about 11 seconds (which is very long), indicating poor blood flow
• Some dilation and moderate valve problems in other parts of the leg’s main vein
• Big varicose veins closer to the surface, also with poor flow
• Signs of venous blockage in a larger vein near the groin (common femoral vein)

On the right leg, Antonio has some vein valve problems, but it’s less severe and he has not yet had treatment there.

Interpretation:
The swelling and valve problems on the left side, starting high near the groin, strongly suggest that there is a blockage or compression in the large iliac vein inside the pelvis. This condition is often caused by May-Thurner syndrome or other causes compressing the iliac vein, leading to blood backing up in the leg veins and causing varicose veins to worsen.

Plan:

Antonio will have a specialized ultrasound of his left iliac vein to check for compression or blockage.

Treatment of the left leg varicose veins will be postponed until this testing is done so that any blockage can be treated first. This prevents the veins from becoming a problem again after treatment.

Meanwhile, Antonio will receive treatment for his right leg vein problems, including closing the faulty vein using a minimally invasive technique and removing problematic surface veins.

Summary:
Antonio’s case shows how large varicose veins starting high near the groin combined with a history of varicocele suggest that there is increased pressure in the pelvic veins. It’s important to check for blockage inside the pelvis and treat that before fixing veins lower in the leg. Meanwhile, treatment can proceed safely on the other leg.