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Varicose veins

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 22 Sep 2025
最后更新： 06 Jul 2023

小结

定义

病史和体格检查

关键诊断因素

  • dilated tortuous veins
完整详情

其他诊断因素

  • leg fatigue or aching with prolonged standing
  • leg cramps
  • restless legs
  • hemosiderin deposition
  • corona phlebectatica
  • itching
  • lipodermatosclerosis
  • ankle swelling
  • ulceration
  • bleeding from varices
完整详情

危险因素

  • increasing age
  • family history
  • female sex
  • increasing numbers of births
  • deep vein thrombosis
  • occupation with prolonged standing
  • obesity
完整详情

诊断性检查

首要检查

  • duplex ultrasound
完整详情

治疗流程

持续性治疗

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

撰稿人

作者

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

利益声明

AHD declares that he has no competing interests.

Tristan RA Lane, MBBS, BSc, PhD, FRCS

Consultant Vascular Surgeon

Cambridge Vascular Unit

Addenbrooke's Hospital

Cambridge University Hospital Trust

Cambridge

Honorary Senior Clinical Lecturer, Section of Vascular Surgery

Department of Surgery and Cancer

Imperial College London

UK

利益声明

TRAL declares that he has no competing interests.

鸣谢

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.

利益声明

LRL, MKS and BT declare that they have no competing interests.

同行评议者

Paul Tisi, MBBS, MS, FRCSEd

Medical Director/Consultant Vascular Surgeon

Bedford Hospital

Bedford

UK

利益声明

PT declares that he has no competing interests.

Nick Morrison, MD, FACS, FACPh

Director

Morrison Vein Institute

Scottsdale

AZ

利益声明

NM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Kakkos SK, Gohel M, Baekgaard N, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021 Jan;61(1):9-82.全文  摘要

Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex scanning and treatment of superficial truncal reflux: endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2023 Mar;11(2):231-261.e6. 摘要

National Institute for Health and Care Excellence. Varicose veins: diagnosis and management. July 2013 [internet publication].全文

De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022 Feb;63(2):184-267.全文  摘要

van der Velden SK, Biemans AA, De Maeseneer MG, et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 2015 Sep;102(10):1184-94. 摘要

Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med. 2019 Sep 5;381(10):912-22. 摘要

Gohel MS, Heatley F, Liu X, et al. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med. 2018 May 31;378(22):2105-14.全文  摘要

Brittenden J, Cotton SC, Elders A, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014 Sep 25;371(13):1218-27.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Varicose veins images

  • 鉴别诊断

    • Telangiectasias
    • Reticular veins
    更多 鉴别诊断

  • 指南

    • 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
    更多 指南

  • 患者教育信息

    Varicose veins: what are they?

    Varicose veins: self-help

    更多 患者教育信息
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