Vericose Veins

 

• Definition and anatomy

  Tortuous, dilated superficial veins, usually in the legs.

  Usually due to valve incompetence. Common sites:

  • The sapheno-femoral junction of the long saphenous vein, which runs along the medial leg.
  • Sapheno-popliteal junction of the short saphenous vein, which runs along the lateral calf.
  • Perforator veins (from deep to superficial), which are on the medial calf.

• Signs and symptoms

  Varicosities:

  • Often asymptomatic, but can cause an aching pain, worse on standing. Check this is not due to other disease – e.g. PVD, arthritis – being wrongly attributed to the more visible veins.
  • Poor cosmesis.
  • Saphena varix: venous dilation at the sapheno-femoral junction.

  Signs of venous disease:

  • Venous ulcers.
  • Venous eczema.
  • Haemosiderin deposition in legs.
  • Lipodermatosclerosis.
  • These changes are commoner with perforator vein incompetence.

• Risk factors

  • Family history.
  • Prolonged standing.
  • Abdominal or pelvic masses compressing IVC or iliac veins e.g. pregnancy, obesity.

• Investigations

  Doppler US.

• Management

  Conservative:

  • Compression therapy: stockings or graded compression bandaging.
  • Weight loss.
  • Avoid prolonged standing.

  Medical:

  • Simple analgesia.

  Surgery:

  • Indications: pain, ulceration, cosmesis (usually not on NHS).
  • Options: SFJ ligation and vein stripping, stab avulsions, radiofrequency or laser ablation, injection of sclerosing foam.
  • Stop oral contraceptive pill 4-6 weeks pre-op due to DVT risk.