ABC of arterial and venous disease: Varicose veins

Abstract

Varicose veins are tortuous, twisted, or lengthened veins. Unless the enlargement is severe, size alone does not indicate abnormality because size can vary depending on ambient temperature and, in women, hormonal factors. In addition, normal superficial veins in a thin person may appear large, whereas varicose veins in an obese person may be hidden. Varicose veins can be classified as trunk, reticular, or telangiectasia. Telangiectasia are also referred to as spider veins, star bursts, thread veins, or matted veins. Most varicose veins are primary; only the minority are secondary to conditions such as deep vein thrombosis and occlusion, pelvic tumours, or arteriovenous fistulae. Incidence and prevalenceA study of people aged 35 to 70 years in London in 1992 concluded that the prevalence of varicose veins in men and women was 17% and 31% respectively. Although varicose veins have traditionally been considered commoner in women, a recent study from Edinburgh of people aged 18 to 64 years found that the prevalence of trunk varices was 40% in men and 32% in women. Over 80% of the total population had reticular varicosities or telangiectasia. There are few studies on the incidence of varicose veins; however, the Framingham study found that the two year incidence of varicose veins was 39.4/1000 for men and 51.9/1000 for women. Pathophysiology and risk factorsThe theory that varicose veins result from failure of valves in the superficial veins leading to venous reflux and vein dilatation has been superseded by the hypothesis that valve incompetence follows rather than precedes a change in the vein wall. Thus, the vein wall is inherently weak in varicose veins, which leads to dilatation and separation of valve cusps so that they become incompetent. This theory is strongly supported by the observation that the dilatation of varicose veins is initially distal to the valve; if the primary abnormality was descending valve incompetence, the initial dilatation should be proximal to the valve.Risk factors for varicose veins include increasing age and parity and occupations that require a lot of standing. There is no evidence that social class, smoking, or genetic makeup influence the prevalence of varicose veins. Obesity is associated with the development of varicose veins in women but not in men. SymptomsThe Edinburgh vein study recently compared the prevalence of symptoms in men and women with and without varicose veins. In men, the only symptom that was significantly associated with trunk varices was itching, whereas in women, heaviness or tension, aching, and itching were significantly associated with trunk varices. No association was found between reticular varices and lower limb symptoms in either men or women. Symptoms associated with varicose veinsx Heaviness x Tension x Aching x Itching Trunk varices are varicosities in the line of the long (top, left) or short (top, right) saphenous vein or their major branches. Reticular veins (arrow, bottom) are dilated tortuous subcutaneous veins not belonging to the main branches ...

Pathogenesis of primary varicose veins

“…Areas of SMC hypertrophy and proliferation occur in the media of varicose veins, although regions of atrophy are also present 13,32,42,45,46,60 . Rearrangement and migration of SMCs into the intima may also be seen 32,43,44,85 .…”

Accuracy of clinical methods and doppler ultrasound in detection of incompetency of sapheno-femoral junction and perforators compared with operative results

“…Fowkes et al and Furlong et al, have mentioned ulceration as the least common presentation, involving 1-2% of individuals but London et al have reported increased incidence of ulceration to 3.6% among people more than 65 years. 8,14,15 In our study, 45 limbs had Sapheno Femoral incompetence which was detected on clinical and doppler evaluation (84.9%). In 8 limbs SFJ was competent (15.1%).…”

“…7 London et al, and Fowkes et al, have also reported that varicose veins are common in elderly people (61% patients more than 55 years of age). 8,9 Abramson JH et al, have reported increased prevalence of varicose veins among women aged 65-74 (54%) and 39% among men aged 75 and above.…”

Compression stockings for varicose veins

“…Varicose veins that have arisen as a result of a known cause, such as a previous deep vein thrombosis, are known as secondary varicose veins (Golledge 2003). Theories on the cause of primary varicose veins range from initial structural weakness within the vein wall which leads to vein dilation, to valve incompetence which leads to pooling of the blood and vein dilation (Golledge 2003;London 2000). The CEAP (Clinical, Etiology, Anatomy, Pathophysiology) classification for chronic venous disorders was developed in 1994 by the American Venous Forum and was revised and disseminated in 2004 (Eklöf 2004), serving as a systematic guide to the diagnosis and classification of chronic venous disorders which was previously lacking.…”