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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
A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management
Management
- Indications for vascular referral
- Symptoms (e.g. pain, aching, discomfort, swelling, heaviness and itching)
- Venous eczema/pigmentation,
- Superficial vein thrombosis
- 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
Reference: NICE ‘CG168 Varicose veins: diagnosis and management’ 2013
Here are some questions
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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