Varicose Veins

Question 1

How do varicose veins develop?

Answer 1

• Veins contain valves that only allow blood to flow one direction – towards the heart
• In the legs this means that as the leg muscles contract, they squeeze blood upwards against gravity
• When these valves become incompetent, the blood pools (drawn by gravity) in the veins and is not effectively pumped back to the heart
• The deep vs superficial veins have a connection called the “perforators” that allow blood to flow from the superficial veins to the deep veins
• When the valves are incompetent in these perforators, blood flows from the deep veins back into the superficial veins and overloads them
• This leads to dilatation and engorgement of the superficial veins

Question 2

What causes varicose eczema and discolouration?

Answer 2

• These veins become leaky due to the pressure, and leak small amounts of blood into the nearby tissues
• The haemoglobin in this blood breaks down to “haemosiderin”, which is deposited around the shins
• This gives a brown discolouration to the lower legs
• This causes the skin to become dry and inflamed. This is called “varicose eczema”
• The skin and soft tissue become fibrotic causing tight, narrowed lower legs. This is called “lipodermatosclerosis”

Question 3

How do varicose veins present?

Answer 3

• Cosmetically unappealing dilated superficial leg veins
• Heavy / dragging sensation in the legs
• Muscle cramps
• Complications

◦Ulcers
◦Infection
◦Thrombophlebitis and DVT

•Positive Trendelenburg’s Test

Question 4

What are some simple ways to manage varicose veins?

Answer 4

◦Mobilising
◦Keep legs elevated when possible to help drainage
◦Compression stockings

Question 5

What are surgical options to manage varicose veins?

Answer 5

◦Endothermal ablation (a catheter is inserted into the vein and radiowaves are used to heat the vein and make it permanently collapse)
◦Sclerotherapy (an injection into the vein causes it to permanently collapse)
◦Stripping (veins are pulled out of the leg)