Varicose Veins

Varicose Veins– Elongated, dilated, and tortuous superficial veins usually seen in the lower extremities.

Causes and Incidence

Varicose veins occur because of incompetency in the valves of the vein, which permits a backflow of blood in the dependent position. The cause of valvular incompetence is unclear, but predisposing factors include familial tendency, inherent weakness in the vein walls, congenital arteriovenous fistulas, pregnancy, ascites, occupations requiring prolonged standing, and vein trauma or occlusion. Varicosities increase with age and are more common in women than in men.

Disease Process

The pathophysiology is unclear. The prevailing hypothesis for pathogenesis is that valve failure occurs at the perforator veins in the lower leg, resulting in high-pressure flow and increased volume in the superficial veins during muscular contraction. Over time the superficial veins become dilated, separating the valve cusps and reversing blood flow in the affected veins.

Symptoms

Initially the vein may be palpated but invisible, and the individual may have a feeling of heaviness in the legs that gets worse at night and in hot weather. Aching also occurs after prolonged standing or walking, during menses, or when fatigued. Over time, the veins can be seen as dilated, purplish, and ropelike.

Potential Complications

Venous insufficiency and venous stasis ulcers are the two most common complications.

Diagnostic Tests

The initial diagnosis is made on inspection and palpation and is checked by a manual compression test that reveals a palpable impulse. A Trendelenburg test can help pinpoint the location of incompetent valves. Plethysmography and ultrasound scans can be used to detect venous backflow.

Treatments

Surgery
Stripping and ligation of severely affected veins.

Drugs
Sclerotherapy (injection of chemicals designed to sclerose the affected veins is sometimes used instead of surgery).

General
Lightweight compression hosiery and avoidance of prolonged standing for mild varicosities; customfitted, surgical weight antiembolism stockings with graduated pressure (high at ankle, lower at top) with prescribed exercise program to promote circulation and prevent stasis with moderate varicosities.