Varicose veins

Question 1

What are varicose veins?

Answer 1

• Dilated, tortuous, superficial veins
• Vast majority in legs
• Incidence roughly equal male:female

Result of incompetence of one or both of two valves at the junctions between the superficial and deep venous system (the saphenofemoral junction SFJ or the saphenopopliteal junction SPJ)

Question 2

What are the causes of varicose veins?

Answer 2

• Primary / idiopathic (most common)
• Obstructive → DVT / pregnancy / pelvic mass
• Congenital abnormality eg. Kippel-Trenauney syndrome

Question 3

What are symptoms of varicose veins?

Answer 3

• Itching
• Aching
• Pain/pressure
• Cosmetic issue

Question 4

What are signs of varicose veins?

Answer 4

• Pitting oedema
• Venous eczema
• Haemosiderin deposit / pigmentation
• Lipodermatosclerosis
• Venous ulcers

Question 5

What investigations are done for varicose veins?

Answer 5

• Necessary to determine which of the valves are incompetent
• Done using handheld doppler
• Duplex ultrasound also required to determine whether deep venous system is functioning sufficiently to allow treatment of superficial veins

Question 6

What is the conservative management of varicose veins?

Answer 6

• Weight loss
• Avoid prolonged standing
• Compression stockings
• Skin care - regular emollients + rapid treatment of ulcers

Question 7

What are the surgical options for varicose veins?

Answer 7

Minimally invasive procedures:

• Injection sclerotherapy
• Radiofrequency ablation or endovascular laser

Surgery - there are multiple more invasive surgical options, depending on the nature of the extent of disease + complications