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

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)

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

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