Varicose veins

Question 1

Varicose veins

Answer 1

Distended superficial veins measure >3mm in diameter

Question 2

Reticular veins

Answer 2

Dilated blood vessels in the skin measuring 1-3mm

Question 3

Telangiectasia

Answer 3

Dilated blood vessels in skin measuring <1mm

Question 4

Risk factors

Answer 4

Increasing age

Female gender

Pregnancy

Obesity

Question 5

Features

Answer 5

May be asymptomatic

Heavy/ dragging sensation in legs

Aching

Itching

Burning

Oedema

Muscle cramps

Restless legs

Signs of chronic venous insufficiency

Question 6

Chronic venous insufficiency

Answer 6

Blood pools in distal veins and leaks into nearby tissues

Haemoglobin breaks down to haemosiderin (gives brown discolouration)

Pooling of blood results in inflammation so skin gets dry and inflamed (venous eczema)

Skin and soft tissue becomes fibrotic and tight (lipdermatosclerosis)

Question 7

Investigations

Answer 7

Venous duplex US will demonstrate retrograde venous flow

Question 8

Management

Answer 8

Weight loss if appropriate

Staying physically active

Keeping leg elevated when possible to help drainage

Compression stockings

Surgery

Question 9

Reasons for referral to secondary care

Answer 9

Significant/ troublesome lower limb symptoms

Previous bleeding from varicose veins

Skin changes secondary to chronic venous insufficiency

Superficial thrombophlebitis

Active or healed venous leg ulcer

Question 10

Possible surgical treatment

Answer 10

Endothermal ablation using radiofrequency ablation or endovenous laser treatment

Foam sclerotherapy (causes inflammatory response and closure of vein)

Ligation or stripping