Varicose Veins

Overview

Snapshot

• A 46-year-old woman presents for the evaluation of “visible” veins in both her lower extremities. She describes this as unappealing, but denies any associated discomfort. She has worked as a cashier for the past 10 years, where she spends the majority of her time standing. On exam, there are palpable, dilated tortuous subcutaneous veins measuring approximately 3.5 mm in diameter while in the upright position.

Introduction

• Varicose veins
  • palpable, distended, tortuous, subcutaneous veins
  • involved vessels
    • saphenous vein
      • also involves saphenous tributaries
      • may involve non-saphenous superficial veins of the leg
• Etiology
  • primary (e.g., primary venous disease)
  • secondary (e.g., previous deep vein thrombosis)
  • congenital (e.g., Klippel-Trenaunay syndrome)
• Pathogenesis
  • may be due to valve incompetence, leading to venous hypertension 
    • may result in inflammation and valve remodeling/loss if there is prolonged venous hypertension
• Epidemiology
  • risk factors
    • advanced age, family history, prolonged standing, and multiparity
• more common in women than in men

Presentation

• Symptoms
  • may be asymptomatic or may describe calf heaviness/swelling
• Physical exam
• palpable, distended, tortuous, subcutaneous veins

Evaluation

• Clinical diagnosis
• Duplex ultrasound

Differential Diagnosis

• Reticular veins
• Telangiectasias

Treatment

• Compression therapy
  • can accompany leg elevation and exercise
• Vein ablation therapy

Prognosis, Prevention, and Complications

• Prognosis
  • in untreated patients
    • may be asymptomatic
    • may result in skin changes, venous ulcers, and superficial thrombophlebitis
• Complications
  • skin changes/venous ulcers
  • may develop complications after certain procedures