Table of Contents
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
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
- Ultrasound‑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.