Varicose veins

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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 referral
    • Bleeding
    • Symptoms (e.g. pain, aching, discomfort, swelling, heaviness and itching)
    • Venous eczema/pigmentation,
    • Superficial vein thrombosis
    • Venous ulceration
  • Management options
    • Conservative: avoid prolonged standing, graduated compression stockings (if no peripheral arterial disease), regular walking, weight loss
    • Endothermal ablation: radiofrequency ablation or endovenous laser ablation
    • Ultrasoundguided 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?

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What are the risk factors for varicose veins?

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What is Trendelenburg test and how is it performed?

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