Dr Rashmi Patel
Psychiatry and Epidemiology Wizard
Video Duration: 11 minutes
Dilated, often palpable subcutaneous veins with reversed blood flow. (As defined by the Vascular Society of Great Britain and Ireland)
Common; Edinburgh Vein Study demonstrated trunk varices in one third of adults aged 18-64.
Female: Male ratio 1.5-3.5:1, and incidence increases with age.
Incompetence of valves between the deep and superficial venous systems of the lower limb result in superficial veins becoming dilated with reversed blood flow from the deep vessels into which they usually drain
Obesity and a low fibre diet are associated with the development of varicose veins.
Genetic component probable
Occupation and increased parity have been suggested as notable factors, but there a lack of good evidence for this.
Uncomplicated Varicose Veins
Often cosmetic complaints are included in the presentation. Various symotoms include pain, itching, tingling a feeling of heaviness
Complicated Vericose Veins
As above, plus complaints of varicose eczema, and more severe pain
Varicose veins will be demonstrable by the patient.
To prove complicated varicose veins, look for lipodermatosclerosis, venous ulcers or corona phlebetatica (dilated vessels of the medial malleolar region; early sign of complicated varicose veins which can haemorrhage or cause ulceration), oedema (although consider alternative causes) and venous eczema.
Tourniquet test is infrequently used in practice but makes for good clinical examination material!
Duplex utrasonography can be used to demonstrate anatomy if a patient is being considered for surgical intervention.
Reassurance for asymptomatic varicose veins is important; in these patients, bleeding, ulceration and thrombosis is unlikely
Compression Hosiery (could be considered conservative)
!! Surgical management is recommended over and above compression hosiery by NICE (CG168) unless the patient is unsuitable for surgical management !!
Results are dependant on compliance, which is very often poor
Good for patients not suitable for surgery, including pregnant women with symptomatic varicose veins
(In order of preference according to NICE)