Varicose veins

Summary

Incidence

More than 50% of men and two-thirds of women have physically identifiable disease. The appearance of varicose veins in childhood is rare although adolescents have incompetent valves. European data indicate that up to 1.5% of adults will suffer a venous stasis ulcer at some point in their lives. Annual healthcare cost in the UK for venous ulceration is estimated at £290 million.

Definition

Varicose veins are abnormal tortuous, dilated, elongated superficial veins. These are most commonly found in the long (LSV) and short saphenous vein (SSV) distribution. Spider veins are dilated smaller cutaneous venules (Figure 105).

Classification: CEAP (clinical, etiological, anatomical, pathological)

Clinical: 0 – no signs of venous disease, 1 – reticular veins, 2 – varicose veins, 3 – oedema, 4 – skin changes (lipodermatosclerosis), 5 – skin changes with healed ulceration, 6 – active ulceration

Aetiological: congenital, primary (no cause), secondary (deep vein thrombosis, traumatic, etc.)

Anatomical: superficial, perforator or deep; location (long or short saphenous)

Pathological: reflux, obstruction, both.

Aetiology

The risk factors for varicose vein include prolonged standing, hereditary, female sex, parity and history of phlebitis. Venous ulcers on the other hand have different risk factors and include old age, obesity, hypertension, trauma, history of venous thrombosis, and low socioeconomic status.

Symptoms

Symptoms range from cosmetic to intractable pain. A burning sensation over the varicose veins is caused by local pressure on cutaneous sensory nerves. In early stages, it causes mild swelling, heaviness and easy fatigability. Dull pain and aching usually starts in the afternoon after long standing and is relieved with leg elevation. Itching is a manifestation of local cutaneous stasis and precedes the onset of dermatitis.