Varicose Veins - Causes, Symptoms and Complicatons

What are Varicose Veins

The WHO defines varicose veins as saccular dilatations of veins, often being tortuous. Varicose veins can be classified as trunk varicosities, reticular varicosities or telangiectasia (thread veins). Although the majority of varicose veins are primary (due to inherent weakness of the wall of the veins), there are secondary causes also, need to be recognized, as they are managed differently.

Varicose veins occur in approximately 17% of males and 31% of females between the ages of 35 and 70 years. The prevalence increases with age. Varicose veins are more common in women and in developed countries.

How Varicose veins develop?

Venous return is dependent on venous valve integrity. Varicose veins are the manifestation of venous reflux and vein dilatation that develop due to imbalance between hydrostatic (gravitational) and hydrodynamic (muscle pump) forces within the limbs. The risk factors for the development of venous insufficiency can be primary or secondary.

In primary disease, there is an inherent weakness within the walls of the vein, causing dilatation and widening of the space between valve cusps. As the valve becomes incompetent, hydrostatic forces increase and lead to peripheral pooling, standing columns of blood within the veins and the development of varicosities. A genetic predisposition in the development and severity of varicosities can be identified in up to 70% of patients.

Secondary causes are damage to the venous walls (deep venous thrombosis), outflow obstruction (pelvic tumours) and, rarely, congenital absence of venous valves.

The sizes of the veins, though are unrelated to the extent or severity of complications.

Risk factors for the development of venous insufficiency

Primary
#Age
#Female sex
#Contraceptive pill use
#Prolonged standing
#Obesity
#Positive family history

Secondary
#Deep venous valvular insufficiency
#Incompetent perforating veins
#Venous outflow obstruction (pelvic tumours)
#Congenital abnormalities
#Arteriovenous malformation

Symptoms of varicose veins:

The majority of patients with varicose veins are asymptomatic. Of symptomatic patients, men often attend complaining of itch whilst females usually present with heaviness, tension and aching. Up to a third of patients' symptoms can be attributed to other problems. It is vital to ascertain whether the patient has had varicose vein surgery in the past and/or suffered a deep venous thrombosis or thrombophlebitis. These conditions make varicose vein surgery more difficult and increase the likelihood of deep venous insufficiency for which treatment is markedly different.

The distribution of disease, particularly whether the long, short or both saphenous veins are involved is determined by the clinician.


Complications of varicose veins

#Bleeding
#Ulceration
#Thrombophlebitis
#Complications of venous hypertension
#Pigmentation
#Lipodermatosclerosis
#Oedema
#Eczema

Varicose Veins - Causes, Symptoms and Complications
Diagnosis of Varicose Veins
Varicose Vein - Treatment and Prognosis