Varicose veins

Background

  • dilated, palpable, often tortuous subcutaneous veins >3mm in diameter
  • usually involve saphenous veins, saphenous tributaries, and/or non-saphenous superficial leg veins

Causes

  • Primary
    • most common cause, usually due to intrinsic biochemical or morphological abnormality in vein wall, may occur in setting of valvular incompetence
  • Secondary
    • previous DVT
    • AV fistula
    • deep vein obstruction
    • superficial thrombophlebitis
  • Congenital causes i.e. venous malformations

Pathogenesis

  • venous valve incompetence may be due to primary, secondary, or congenital causes –> key mechanism leading to venous hypertension
  • venous hypertension believed to underlie all or most signs of chronic venous disease, including varicose veins
    • reflux through incompetent valves
    • obstruction due to secondary causes
    • calf muscle pump failure due to immobility, obesity

Examination

  • Complete vascular exam to rule out underlying peripheral arterial disease
  • Skin changes may or may not be present with varicose veins:

Differential Dx

  • Reticular veins
  • Telangiectasias

Testing

  • Duplex u/s
  • Thrombophilia screen may be required
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