Table of Contents
Varicose veins are tortuous, dilated veins of the superficial venous system.
Pathophysiology
- Incompetent valves in perforating veins cause retrograde blood flow from the deep to superficial veins of the leg
- This results in increased pressure and dilation of the superficial veins
- Risks: age, female > male, previous DVT, obesity, pregnancy
Clinical features
Symptoms
- Most are asymptomatic except for aesthetic problems but patient may have pain, cramps, heaviness, tingling and restless legs
Signs
- Oedema
- Varicose eczema
- Venous ulcers
- Haemosiderin deposits
- Phlebitis
- Lipodermatosclerosis (subcutaneous fibrosis due to chronic inflammation and fat necrosis)
- Atrophie blanche (white scarring around healing ulcer)
- Saphena varix: dilation of the saphenous vein at its confluence with the femoral vein (transmits a cough impulse)
Investigations
- Colour flow duplex ultrasound
Management
- Refer if: bleeding, pain, ulceration, thrombophlebitis, severe impact on quality of life
- Management options
- Conservative: avoid prolonged standing, graduated compression stockings (if no peripheral arterial disease), regular walking, weight loss
- Injection sclerotherapy: sclerosant injected at multiple sites in varicosities
- Phlebectomy: stab avulsion or mechanical avulsion
- Endovenous laser ablation
- Radiofrequency ablation
- Surgical stripping
