Varicose veins

Question 1

What are varicose veins?

Answer 1

Distended superficial veins measuring more than 3mm in diameter, usually affecting the legs

Question 2

What is the pathology of varicose veins?

Answer 2

The deep and superficial veins are connected by vessels called the perforating veins, which allow blood to flow from the superficial veins to the deep veins. When the valves are incompetent in these perforating veins, blood flows from the deep veins back into the superficial veins and overloads them. This leads to dilatation and engorgement of the superficial veins, forming varicose veins

Question 3

1) In chronic venous insufficiency, what causes the brown discolouration of the legs?
2) What does Pooling of blood in the distal tissues result in?
3) This causes the skin to become dry and inflamed - what is this called?
4) This also causes the skin and soft tissues to become fibrotic and tight, causing the lower legs to become narrow and hard - what is this called?

Answer 3

1) When blood pools in the distal veins, the pressure causes the veins to leak small amounts of blood into the nearby tissues. The haemoglobin in this leaked blood breaks down to haemosiderin, which is deposited around the shins in the legs giving a brown discolouration
2) Inflammation
3) Venous eczema
4) Lipodermatosclerosis

Question 4

Name 2 risk factors for developing varicose veins

Answer 4

• Increasing age
• Family history
• Female
• Pregnancy (often improves after pregnancy finishes)
• Obesity
• Prolonged standing i.e. occupations involving standing for long periods
• Deep vein thrombosis

Question 5

1) Name 2 symptoms varicose veins may also present with
2) Name a symptom of chronic venous insufficiency

Answer 5

1) Heavy or dragging sensation in the legs, aching, itching, burning, oedema, muscle cramps, restless legs
2) Ulcers, skin changes