Varicose veins are dilated, tortuous, superficial veins that occur secondary to incompetent venous valves, allowing blood to flow back, away from the heart. They most commonly occur in the legs due to reflux in the great saphenous vein and small saphenous vein. Whilst extremely common, the vast majority of patients do not require any intervention.

Risk factors

• increasing age
• female gender
• pregnancy
  • the uterus causes compression of the pelvic veins
• obesity

For many patients, the cosmetic appearance may prompt presentation. However other patients may complain of symptoms:

• aching, throbbing
• itching

Other patients may present with complications of varicose veins:

• a variety of skin changes may be seen:
  • varicose eczema (also known as venous stasis)
  • haemosiderin deposition → hyperpigmentation
  • lipodermatosclerosis → hard/tight skin
  • atrophie blanche → hypopigmentation
• bleeding
• superficial thrombophlebitis
• venous ulceration
• deep vein thrombosis

Lipodermatosclerosis on the ankle of an older male patient. Note the hyperpigmentation secondary to haemosiderin deposition and the appearance of tight skin

Investigation

• venous duplex ultrasound: this will demonstrate retrograde venous flow
• ? CT Venogram - maybe later before Sx