Varicose Veins

Question 1

What are varicose veins?

Answer 1

Tortuous dilated segments of veins

Question 2

What causes varicose veins?

Answer 2

Arise from incompetent valves from deep veins to superficial veins - at sapheno-femoral & sapheno-popliteal junctions

Results in venous hypertension and dilatation of superficial veins

98% are primary idiopathic

Question 3

Risk factors for varicose veins

Answer 3

Prolonged standing
Obesity
Pregnancy
Family history

Question 4

What are the symptoms of varicose veins?

Answer 4

Cosmetic issues
Pain
Aching 
Swelling
Itching

Question 5

What is a saphena varix?

Answer 5

Dilatation of the saphenous vein at the sapheno-femoral junction

Commonly mistaken for a femoral hernia

Question 6

What is the CEAP classification?

Answer 6

Standardised reporting method of clinical manifestations of varicose veins

Clinical features

• C0 = no visible/palpable signs of venous disease
• C1 = telangiectasia or reticular veins
• C2 = varicose veins
• C3 = oedema
• C4a = pigmentation or eczema
• C4b = lipodermatoslerosis
• C5 = heaped venous ulcer
• C6 = active venous ulcer

aEtiology

• Ec = congenital
• Ep = primary
• Es = secondary
• En = no venous disease

Anatomical

• As = superficial veins
• Ap = perforating veins
• Ad = deep veins
• An = no venous location identified

Pathophysiology

• Pr = reflux
• Po = obstruction
• Pr,o = reflux & obstruction
• Pn = no venous pathophysiology identifiable

Question 7

Investigations for suspected varicose veins

Answer 7

Duplex ultrasound to asses valve incompetence

Question 8

Management for varicose veins

Answer 8

Compression stockings

Surgical treatment indicated

• symptomatic
• lower-limb skin changes
• superficial vein thrombosis
• venous leg ulcer

Surgical treatments

• vein ligation, stripping, avulsion
• thermal ablation