(GP)

Overview

• Subcutaneous, permanently dilated veins ≥3 mm diameter when measured in a standing position; however, they may not be visible.
• Most commonly the superficial veins of the lower limbs (most commonly occur in the legs due to reflux in the great saphenous vein and small saphenous vein)
  • Long Saphenous Vein ⇒ travels above medial malleolus and medial aspect of thigh
  • Short Sapehnous Vein ⇒ originates from lateral malleolus
• Very common → affects up to 40% of the population, but not all are symptomatic
• Prevalence increases with age
• Risk Factors → increasing age, family history, female sex, increasing numbers of births, obesity, occupations with prolonged standing and deep vein thrombosis
• Elevated venous pressure → incompetence of venous valves → reflux of blood back into superficial veins → further elevation of venous pressure → formation of varicose veins

Making Diagnosis

Clinical Features:

• Dilated Tortuous Veins → with the patient standing, the skin is examined visually and by palpation for irregularities and bulges consistent with varicose veins
• Leg Fatigue or Aching → worse with prolonged standing
• Leg Cramps
• Restless Legs
• Swelling
• Skin Changes
  • varicose eczema (also known as venous stasis)
  • haemosiderin deposition → hyperpigmentation (brown skin)
  • lipodermatosclerosis → hard/tight skin, then champagne bottle appearance of leg
  • atrophie blanche → hypopigmentation