Varicose veins

Definition
  • Varicose veins: Dilated, tortuous, and elongated superficial veins, typically seen in the legs.
Etiology & Pathophysiology
  • Valvular incompetence in superficial veins.
  • Increased venous pressure leading to vein dilation and valve failure.
  • Primary varicose veins: Due to congenital weakness of vein wall.
  • Secondary varicose veins: Due to a known cause like deep vein thrombosis.
Risk Factors
  • Family history.
  • Ageing.
  • Female gender (hormonal influences).
  • Pregnancy.
  • Obesity.
  • Prolonged standing.
  • Deep vein thrombosis history.
Clinical Presentation
  • Visible dilated veins on legs.
  • Leg heaviness or ache.
  • Nocturnal cramps.
  • Itching over veins.
  • Swelling in legs and ankles.
  • Skin discolouration, especially near the ankles (haemosiderin staining).
  • Complications: eczema, ulcers, bleeding, thrombophlebitis.
Investigations
  • Doppler ultrasound: To evaluate venous reflux and patency.
  • Venography (less commonly used).
Management
  • Conservative: Compression stockings, elevation of legs, lifestyle modifications (e.g., weight loss, avoid prolonged standing).
  • Interventional: Sclerotherapy, endovenous laser therapy, radiofrequency ablation.
  • Surgical: Ligation and stripping, phlebectomy.
Prevention
  • Regular exercise.
  • Maintaining a healthy weight.
  • Avoiding prolonged standing or sitting.
  • Use of compression stockings if at risk.

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