Varicose veins are very common, affecting up to 40% of the population, but not all are symptomatic.
Clinical presentation includes lower extremity pain, fatigue, itching and/or heaviness, which often worsen with prolonged standing, associated with dilated tortuous veins.
Varicose veins can lead to significant quality of life impairment in affected individuals.
Underlying venous insufficiency can be documented by duplex ultrasound.
Treatment options for symptomatic varicose veins include endovenous thermal ablation, foam sclerotherapy, and open surgery.
Compression hosiery should be reserved for those unsuitable for intervention, those who are unfit, and as long-term management for those with chronic venous diseases or healed ulceration.
Chronic venous skin changes, superficial venous thrombosis, venous ulceration, and bleeding are recognized complications.
Varicose veins are subcutaneous, permanently dilated veins, often significantly more noticeable on standing; however, they may not be visible.
History and exam
Key diagnostic factors
- dilated tortuous veins
Other diagnostic factors
- leg fatigue or aching with prolonged standing
- leg cramps
- restless legs
- hemosiderin deposition
- corona phlebectatica
- ankle swelling
- bleeding from varices
- increasing age
- family history
- female sex
- increasing numbers of births
- deep vein thrombosis
- occupation with prolonged standing
1st investigations to order
- duplex ultrasound
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
- Reticular veins
- ACR appropriateness criteria®: lower extremity chronic venous disease
- European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs
Varicose veins: what are they?
Varicose veins: what treatments work?More Patient leaflets
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