The Case of GSV Transient (Evening, Orthodependent) Reflux in a Hip Going into the Tributary in Woman with Reticular Varicose Veins (C1s)

A 41-year-old woman presents with complaints of aesthetic defect of legs. She works as a shop assistant in a store. Her working day in a standing position lasts up to 10 hours. She has been pregnant twice and now has two children. She notes the family history of varicose veins from mother’s side. While evening examination at 6 p.m. (after her working day) the skin is of normal colour and there is an artery pulsation in all pulse points. Both hip superficies contain spider veins and single reticular varicose. She states leg heaviness and tiredness, aching in the internal hip surface of the right leg in its lower part at the end of the working day, night cramps. The results of DS after «a day orthostatic loading test» (shortly DOL-test) showed that the diameter of GSV in the right area of saphenofemoral junction is 6.5 mm which is the same for the area between the middle and the lower third of the hip. There is a 12 cm reflux in the middle third of the hip going into the extended hypodermic tributary with commissural GSV valve insufficiency in the area between the middle and the lower third (Figure 1).