Varicose Veins

Overview – Varicose Veins

Varicose veins are dilated, tortuous superficial veins caused by venous valve incompetence, most commonly in the lower limbs. Varicose veins are a common chronic vascular disorder with a mechanical basis, often exacerbated by prolonged standing, obesity, and pregnancy. While primarily a cosmetic and comfort concern, complications such as ulcers and thrombophlebitis can occur, making clinical recognition and management important.

Definition

  • Varicose veins are abnormally enlarged, twisted superficial veins, usually in the lower limbs, caused by valve failure and venous stasis.

Aetiology

  • Mechanical factors: Prolonged leg dependency
  • Risk factors include:
    • Obesity
    • Pregnancy
    • Family history (genetic predisposition)

Pathophysiology

  • Incompetence of superficial venous valves → retrograde blood flow
  • Venous dilation → worsened valve dysfunction
  • → Venous congestion, oedema, local inflammation, and thrombosis
  • Commonly affects superficial leg veins but can also occur in:
Varicose Veins Incompetent valves
Blausen Medical Communications, Inc., CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons
Varicose Veins Diagram
Jmarchn, modified from Varicose veins.jpg of National Heart Lung and Blood Institute (NIH), CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

Clinical Features

Symptoms

  • Diffuse aching and heaviness
  • Night-time leg cramping and tightness
  • Persistent lower limb oedema
  • Delayed wound healing

Signs

  • Visible, distended, tortuous superficial veins
  • Skin changes (e.g. stasis dermatitis, pigmentation)
  • Venous leg ulcers, especially near the medial malleolus

Note: Embolism is rare because only superficial veins are involved.

Varicose Veins - Clinical Photograph
CNX OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

Complications

  • Recurrent superficial thrombophlebitis
  • Lipodermatosclerosis (fibrosis and skin induration)
  • Skin ulceration
  • Haemorrhage (e.g. from ruptured varicosities)

Investigations

  • Trendelenburg Test:
    • Performed supine with elevation of the leg
    • Occlude the saphenous vein at the thigh
    • On standing, if veins rapidly refill from above → positive test (valvular incompetence)
  • Duplex ultrasound may also be used for definitive assessment.

Management

Conservative

  • Leg elevation
  • Compression stockings
  • Regular exercise and weight loss

Surgical

  • Vein stripping (removal of varicose veins)
  • Alternatives: Endovenous laser therapy, sclerotherapy, radiofrequency ablation

Differential Diagnosis

Summary – Varicose Veins

Varicose veins are superficial venous dilations caused by valve incompetence, presenting with leg discomfort, visible veins, and complications such as ulcers or thrombophlebitis. Though embolism is rare, appropriate conservative or surgical management can significantly improve quality of life. For a broader context, see our Cardiovascular Overview page.

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