Varicose Veins

Question 1

Pathophysiology of varicose veins

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

Presentation of varicose veins

Answer 2

• 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 3

Management of varicose veins

Answer 3

• Simple measures
  
  • Mobilising
  • Keep legs elevated when possible to help drainage
  • Compression stockings
• Surgical options
  
  • 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)