Varicose veins ✅

Varicose veins are enlarged, tortuous superficial veins of the lower limbs caused by venous insufficiency and valve incompetence, leading to retrograde flow and venous pooling. They are common and often asymptomatic, but can also cause discomfort and serious complications such as skin changes, bleeding and ulcers. The great saphenous vein (GSV) is most commonly involved.

⚠️ Causes & Risk Factors

• 📈 Age: Prevalence increases with age.
• ♀️ Gender / Hormonal: Pregnancy, menopause and OCP use increase risk.
• 🤰 Pregnancy: Increased blood volume & pelvic vein compression predispose.
• 🧍 Prolonged standing/sitting: Impaired venous return.
• ⚖️ Obesity: Higher venous pressure.
• 👨‍👩‍👧 Family History: Genetic predisposition common.
• 🩺 Previous DVT: Valve damage → chronic insufficiency.

🔬 Pathophysiology

• Valve incompetence → retrograde flow (reflux).
• ↑ Venous pressure → pooling, wall dilation and tortuosity.
• Superficial system (esp. GSV) affected; deep venous system remains until advanced disease.

👀 Clinical Features

• 👁️ Visible veins: Dilated, twisted, bluish veins along leg contours.
• 🦵 Leg heaviness/aching: Worse with prolonged standing, relieved by elevation.
• 💧 Swelling: Ankles/lower legs, particularly evening.
• 🔥 Itching/Burning: Perivenous irritation.
• 🌙 Night cramps: Common complaint.
• 🎨 Skin changes: Hyperpigmentation, venous eczema, lipodermatosclerosis.
• 🦶 Ulceration: Typically around medial malleolus with chronic insufficiency.

🚨 Complications

• 🩹 Superficial thrombophlebitis: Painful, red, tender cord in vein.
• 🦶 Venous ulcers: Slow‑healing, often below knee.
• 💉 Bleeding: From superficial fragile veins.
• 🧴 Chronic Venous Insufficiency: Skin fibrosis and stasis changes.

🧪 Diagnosis

• 👨‍⚕️ Clinical exam: Inspection of varicosities, assessment of symptoms and skin changes.
• 🩻 Doppler/duplex ultrasound: Gold standard to confirm reflux and plan intervention. :contentReference[oaicite:1]{index=1}
• 📊 Plethysmography: Rarely needed; specialised function testing.

🩺 Conservative Management

• 🧦 Compression stockings: May relieve symptoms when intervention unsuitable. NICE notes hosiery alone is not preferred over procedural options. :contentReference[oaicite:2]{index=2}
• 🛏️ Leg elevation: Reduces venous pressure & oedema.
• ⚖️ Weight loss: Improves venous return.
• 🚶 Exercise: Walking activates calf muscle pump.
• ⏳ Avoid prolonged standing/sitting: Regular mobility & ankle exercises.

🔧 Interventional Treatments

• 💉 Endovenous Laser Ablation (EVLA): Thermal closure of incompetent veins.
• 📡 Radiofrequency Ablation (RFA): Alternative thermal method. :contentReference[oaicite:4]{index=4}
• 💉 Ultrasound‑guided Foam Sclerotherapy: Chemical ablation when thermal methods unsuitable.
• ✂️ Ambulatory Phlebectomy: Minimally invasive removal of superficial veins.
• 🩺 Vein Stripping & Ligation: Traditional surgery if less invasive techniques unsuitable.

🛡️ Prevention

• 🏃 Regular exercise (calf strengthening).
• ⚖️ Healthy BMI.
• 🚶‍♂️ Avoid prolonged static posture; encourage movement.
• 🧦 Compression hosiery in high‑risk groups when appropriate.
• 🛏️ Elevate legs when resting.

📌 Conclusion

Varicose veins are common and often benign, but can lead to significant discomfort and complications such as ulcers, thrombophlebitis and bleeding. NICE recommends clinical assessment with duplex ultrasound for symptomatic cases and referral to a vascular service for planning of interventional treatment when appropriate. Early recognition, lifestyle measures and appropriate referral improve outcomes and quality of life.

Exam Tip: Always include clinical features, Doppler ultrasound as key diagnostic tool, referral criteria, and complications (ulcer, thrombophlebitis, bleeding) in OSCE answers. 🚑

📚 NICE References

• NICE CG168: Varicose Veins – Diagnosis and Management
• NICE Varicose Veins Topic Overview
• NICE IPG440: Ultrasound‑guided Foam Sclerotherapy