Clinically speaking, most patients begin having symptoms of vague pain—usually daily heavy/tired sensations of the affected extremity(ies)—when C2 stage achieved. Sometimes during C2 stage, there is no visible varicosed branch vein(s) to confirm the venous problem. As patients progress in to stage C3, the symptoms typically escalate with obvious swelling, more prominent in the afternoon/evening hours while up against gravity during the day. Pain intensifies in each stage progression, and amazingly, a small subset of patients who progress in to stages C2 – C6 never show any branch vein varicosed veins. Yet, a culprit trunk vein is causative below the surface and is only detected with duplex venous ultrasound. Such patients can complain for years and be mis-diagnosed. It takes a high level suspicion on the part of such a patients primary care provider, or a savvy patient reading this website, to call and schedule a simple in-office consultation to rule in/out.

If you have any pain and/or swelling in your lower extremity(ies) on a consistent basis, even without visible varicose veins (meaning you are clinically classified as C0 or C1), you are never wrong to schedule a consultation including standing venous ultrasound. Insurers will cover this initial consultation. 10-15% of the population who undergo such evaluations have occult venous disease amenable to minor-surgical non-hospital curative procedures that insurance will cover in most cases.