Table of Contents PathophysiologyClinical features SymptomsSignsInvestigationsManagement Here are some questions Learn the focussed examination too…Varicose veins focussed examination covered here! 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 Long saphenous vein distribution 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 Indications for vascular referralBleedingSymptoms (e.g. pain, aching, discomfort, swelling, heaviness and itching)Venous eczema/pigmentation,Superficial vein thrombosis Venous ulceration Management optionsConservative: avoid prolonged standing, graduated compression stockings (if no peripheral arterial disease), regular walking, weight lossEndothermal ablation: radiofrequency ablation or endovenous laser ablationUltrasound‑guided foam sclerotherapy: sclerosant injected at multiple sites in varicosities Surgical stripping Reference: NICE ‘CG168 Varicose veins: diagnosis and management’ 2013 Here are some questions What is a saphena varix? Oops! This section is restricted to members. What are the risk factors for varicose veins? Oops! This section is restricted to members. What is Trendelenburg test and how is it performed? Oops! This section is restricted to members.