Varicose veins are dilated, tortuous, superficial veins in the lower limb which occur in association with the course of the long saphenous vein and the short saphenous vein. The prevalence of varicosities is 80% in people over the age of 60. Around 12% of these are symptomatic.
Pain and cramping in the affected leg which is worse after prolonged standing.
Concern about the cosmetic appearance. Patient feels they have ugly legs.
Haemosiderin skin pigmentation
Phlebitis (often recurrent)
- Stand the patient up and observe, looking for; ulceration, haemosiderin, eczema, thin skin.
- Palpate for; tenderness over varices (phlebitis) or hardness (thrombosis).
- Determine the location of the filling insufficiency using a tourniquet test:
- Elevate the limb to empty veins
- Place a tourniquet around the thigh and the stand the patient up
- If filling of the varicose vein is controlled then the main filling communication is at the saphenofemoral junction.
- If filling not controlled repeat the test with the tourniquet above the knee.
- If this controls filling then the communication is via the mid thigh perforating vein.
- If filling is not controlled repeat the test with the tourniquet just below the knee.
- If this controls filling then the communication is via the popliteal perforating veins.
- If filling remain uncontrolled then more distal perforating veins are responsible.
- Further examination may include Perthes’ test and duplex ultrasound.
- Conservative: Advise the patient to avoid standing for long periods, wear support stockings, loose weight and take regular walks.
- Medical: Injected sclerosants (little evidence of benefit when used as sole treatment)
- Surgical: Includes high saphenous ligation, saphenous stripping, multiple avulsions.