A 42-year-old man presented with very large lower limb varicose veins bilaterally and an 8-month history of fainting when standing up from a squatting position. He had been investigated for syncope by a cardiologist with no abnormality found on ECG, Echocardiogram, 24-hour ECG or 48-hour blood pressure monitoring. Venous duplex ultrasonography showed bilaterally Great Saphenous Vein (GSV) reflux, with each vein having a diameter of 23.5 and 24.0 mm at the groin, and a similar dilation along the whole vein to ankle. These veins were successfully ablated with endovenous laser ablation, immediately following which the syncope disappeared and has not returned. We calculate that before treatment, the patient had approximately 500mls of blood refluxing passively with gravity on standing into his incompetent GSVs and associated varicosities, which would account for his postural syncope.
Whiteley, M. S., & Kiely, M. J. (2023, May 22). Syncope (fainting on standing from squatting) due to massive venous reflux into lower limb varicose veins. https://doi.org/10.31219/osf.io/me5c7
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