Varicose veins

Last reviewed: 25 Aug 2022
Last updated: 06 Mar 2020

Summary

Definition

History and exam

Key diagnostic factors

  • dilated tortuous veins
More key diagnostic factors

Other diagnostic factors

  • leg fatigue or aching with prolonged standing
  • leg cramps
  • restless legs
  • hemosiderin deposition
  • corona phlebectatica
  • itching
  • lipodermatosclerosis
  • ankle swelling
  • ulceration
  • bleeding from varices
Other diagnostic factors

Risk factors

  • increasing age
  • family history
  • female sex
  • increasing numbers of births
  • deep vein thrombosis
  • occupation with prolonged standing
  • obesity
More risk factors

Diagnostic investigations

1st investigations to order

  • duplex ultrasound
More 1st investigations to order

Treatment algorithm

ONGOING

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.

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