Varicose veins are dilated superficial veins in the lower extremities. Usually, no cause is obvious. Varicose veins are typically asymptomatic but may cause a sense of fullness, pressure, and pain or hyperesthesia in the legs. Diagnosis is by physical examination. Treatment may include compression, wound care, sclerotherapy, and surgery.
Etiology is usually unknown, but varicose veins may result from primary venous valvular insufficiency with reflux or from primary dilation of the vein wall due to structural weakness. In some people, varicose veins result from chronic venous insufficiency and venous hypertension. Most people have no obvious risk factors. Varicose veins are common within families, suggesting a genetic component. Varicose veins are more common among women because estrogen affects venous structure, pregnancy increases pelvic and leg venous pressures, or both. Rarely, varicose veins are part of Klippel-Trénaunay-Weber syndrome, which includes congenital arteriovenous fistulas and diffuse cutaneous capillary angiomas.
Symptoms and Signs
Varicose veins may initially be tense and palpable but are not necessarily visible. Later, they may progressively enlarge, protrude, and become obvious; they can cause a sense of fullness, fatigue, pressure, and superficial pain or hyperesthesia in the legs. Varicose veins are most visible when the patient stands.
For unclear reasons, stasis dermatitis and venous stasis ulcers are uncommon. When skin changes (eg, induration, pigmentation, eczema) occur, they typically affect the medial malleolar region. Ulcers may develop after minimal trauma to an affected area; they are usually small, superficial, and painful.
Varicose veins occasionally thrombose, causing pain. Superficial varicose veins may cause thin venous bullae in the skin, which may rupture and bleed after minimal trauma. Very rarely, such bleeding, if undetected during sleep, is fatal.
- Clinical evaluation
- Sometimes Doppler ultrasonography
Diagnosis is usually obvious from the physical examination. Trendelenburg test (comparing venous filling before and after release of a thigh tourniquet) is no longer commonly used to identify retrograde blood flow past incompetent saphenous valves.
Duplex ultrasonography is an accurate test, but it is not clear whether it is routinely necessary.
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