Vascular Surgeon
Expert in the treatment of varicose veins
After the summer, is now the right time to have your legs checked? Five questions for Dr Pittaluga
This summer, spells of intense heat put our veins to the test. Heavy legs, swollen ankles, pain at the end of the day: many people gritted their teeth and told themselves it would pass once the heatwave was over. Temperatures dropped, the symptoms often eased, and the matter was closed. That is exactly where the misunderstanding lies.
1. This summer was marked by intense heat. Did you see any consequences in your patients?
Yes, and of two different kinds.
The first is mechanical. Heat dilates the veins. When the valve system is working properly, that dilation has no consequences. When it is already weakened, even in the absence of visible varicose veins, the veins cope less well: blood pools more in the legs, and symptoms either appear or get markedly worse. Heaviness, swollen ankles, pain at the end of the day, night cramps, restless legs.
The second is more concerning. Intense heat often comes with dehydration, and summer brings long stretches of immobility: car journeys, flights, waiting around. That combination increases the risk of clotting. This summer I saw cases of superficial vein thrombosis, what patients sometimes call a superficial phlebitis, and deep vein thromboses that could have been dealt with earlier.
What struck me most was the delay. A lot of patients waited several weeks before coming in, telling themselves the heat explained everything.
2. Which problems may have gone unnoticed this summer?
The most common reaction, and the most understandable one, is to put everything down to the heat. “It's 38 degrees, everyone has heavy legs.” That is partly true, and it is also what can mask three very different situations.
- Venous disease coming to light. The symptoms were not caused by the heat, they were caused by venous reflux that the heat simply brought to the surface. The heat did not create the problem, it revealed it.
- A superficial vein thrombosis mistaken for something else. A hard, red, painful cord running along the line of a vein is often taken for a knock or an insect bite and treated with a cream. It warrants examination, not least because it can extend, or be associated with a deeper problem.
- Swelling in one leg only. Asymmetry is the signal that matters. A leg that is noticeably larger, warmer or more painful than the other, particularly after a long journey, calls for a deep vein thrombosis to be ruled out. Left untreated, it can lead to serious complications and cause lasting damage to the venous system.
I would add a point that often surprises people: you can have serious venous disease with no visible varicose vein, in cases of excess weight for example, and conversely you can have prominent veins that are entirely harmless. The naked eye cannot be the only judge.
3. My symptoms have gone since the temperatures dropped. So the problem is solved?
This is the most important question in this article, and the answer is no.
You have to separate the symptoms from their cause. What eased as the temperatures dropped were the symptoms. The cause is still there. When a vein no longer does its job, the problem is mechanical and, in most cases, lasting: it rarely resolves itself with the arrival of autumn. The heat was an aggravating factor, not the problem itself. So the trap is twofold. First, the improvement creates a false sense of security, and the matter is forgotten until the next hot spell. Second, venous disease is progressive: a year later, you are not starting from the same place. What could have been managed with simple monitoring sometimes calls for more substantial treatment.
There is some good news about the timing, though. Autumn and winter are the right time to take stock and, if necessary, to be treated. It is cooler, compression is easier to wear, and it leaves time to get everything settled well before next summer. Putting it off until the heat returns means running the risk of the disease progressing, with a greater chance of complications during the summer ahead.
In other words: if your legs troubled you this summer and everything feels fine today, that is not a reason to skip a consultation. Quite the opposite, now is exactly the right time to have one.
4. Which examinations are used to take stock?
Three steps, and they are all straightforward.
The first is taking your history: the symptoms you have felt, when they occur, your personal and family background, your lifestyle and your work. This is essential in guiding the examination and shaping the treatment strategy.
Then comes the clinical examination, which involves inspecting and palpating the leg. It is carried out mainly with the patient standing, on both legs.
Finally, the Doppler ultrasound scan. This is the reference examination. It is painless, non-invasive, with no injection and no radiation: an ultrasound probe, a little gel, around twenty minutes. It shows the direction in which the blood is flowing, checks whether the valves are competent, maps any reflux precisely, and picks up the after-effects of a past thrombosis.
Its main value lies precisely in showing what cannot be seen. It is not unusual for a patient with no obvious varicose vein to have significant reflux, and for another, worried about very prominent veins, to be reassured within minutes. In both cases, the examination has served a purpose.
5. Who should you go and see?
A vascular specialist: a vascular physician, also known as an angiologist or a phlebologist, or a vascular surgeon. Both specialties are trained in Doppler ultrasound and in interpreting the results.
If there is any sign suggesting a deep vein thrombosis, in particular painful swelling in one leg only, the consultation should not wait.
