Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- dilated tortuous veins
Other diagnostic factors
- leg fatigue or aching with prolonged standing
- leg cramps
- restless legs
- haemosiderin deposition
- corona phlebectatica
- itching
- lipodermatosclerosis
- ankle swelling
- ulceration
- bleeding from varices
Risk factors
- increasing age
- family history
- female sex
- increasing numbers of births
- deep vein thrombosis
- occupation with prolonged standing
- obesity
Diagnostic investigations
1st investigations to order
- duplex ultrasound
Treatment algorithm
symptomatic superficial vein insufficiency, no evidence of peripheral vascular disease or superficial axial truncal insufficiency: tributary insufficiency only
symptomatic superficial vein insufficiency, no evidence of peripheral vascular disease or superficial tributary insufficiency: truncal axial insufficiency only
symptomatic superficial vein insufficiency, no evidence of peripheral vascular disease: truncal axial and tributary insufficiency
symptomatic superficial vein insufficiency, no evidence of peripheral vascular disease: perforator veins with reflux located near healed or active venous ulcers
deep vein insufficiency without superficial truncal vein insufficiency but with superficial tributary insufficiency
deep vein insufficiency with superficial truncal vein insufficiency
deep vein insufficiency without superficial vein insufficiency
deep vein obstruction
Contributors
Authors
Alun H Davies, MA, DM, DSc, FRCS, FHEA, FEBVS, FACPh
Professor of Vascular Surgery and Honorary Consultant Vascular Surgeon
Department of Surgery and Cancer
Imperial College London
Imperial Vascular Unit
Imperial College Healthcare NHS Trust
London
UK
Disclosures
AHD declares that he has no competing interests.
Tristan RA Lane, MBBS, BSc, PhD, FRCS
Clinical Lecturer and Post CCT Fellow in Vascular Surgery
Department of Surgery and Cancer
Imperial College London
Imperial Vascular Unit
Imperial College Healthcare NHS Trust
London
UK
Disclosures
TRAL declares that he has no competing interests.
Acknowledgements
Professor Alun Davies and Mr Tristan Lane would like to gratefully acknowledge Dr Luis R. Leon Jr, Dr Maureen K. Sheehan, and Dr Boulos Toursarkissian, previous contributors to this topic.
Disclosures
LRL, MKS and BT declare that they have no competing interests.
Peer reviewers
Paul Tisi, MBBS, MS, FRCSEd
Medical Director/Consultant Vascular Surgeon
Bedford Hospital
Bedford
UK
Disclosures
PT declares that he has no competing interests.
Nick Morrison, MD, FACS, FACPh
Director
Morrison Vein Institute
Scottsdale
AZ
Disclosures
NM declares that he has no competing interests.
Differentials
- Telangiectasias
- Reticular veins
More DifferentialsGuidelines
- Management of venous leg ulcers
- The care of patients with varicose veins and associated chronic venous diseases
More GuidelinesPatient leaflets
Varicose veins: what are they?
Varicose veins: surgery to remove varicose veins
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