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- Superficial venous disease causing a permanent dilatation and tortuosity of superficial veins ≥3 mm in diameter usually occurring in the legs and feet; caused by systemic weakness in the vein wall and may result from congenitally incomplete valves or valves that have become incompetent
- Affects legs where reverse flow occurs when dependent
- Truncal varices involve the great and small saphenous veins; branch varicosities involve the saphenous vein tributaries.
- Categorized as the following:
- Uncomplicated (cosmetic)
- With local symptoms (pain confined to the varices, not diffuse)
- With local complications (superficial thrombophlebitis, may rupture causing bleeding)
- Complex varicose disease (diffuse limb pain, swelling, skin changes/ulcer)
- System(s) affected: cardiovascular; skin
Ulceration of varicose veins has a high rate of infection, which can lead to sepsis.
- Common; usually valvular degeneration but may be secondary to chronic venous insufficiency
- Elastic support hose and frequent rests with legs elevated rather than ligation and stripping
- Frequent problem
- Elastic stockings are recommended for those with a history of varicosities or if prolonged standing is involved.
- Predominant age: middle age
- Predominant gender: female > male (2:1)
- National Women’s Health Information Center estimates that 50% of women have varicose veins.
Etiology and Pathophysiology
- Varicose veins are caused by venous insufficiency from faulty valves in ≥1 perforator veins in the lower leg, causing secondary incompetence at the saphenofemoral junction (valvular reflux).
- Valvular dysfunction causing venous reflux and subsequently venous hypertension (HTN)
- Failed valves allow blood to flow in the reverse direction (away from the heart), from deep to superficial and from proximal to distal veins.
- Deep thrombophlebitis
- Increased venous pressure from any cause
- Congenital valvular incompetence
- Trauma (consider arteriovenous fistula; listen for bruit)
- Presumed to be due to a loss in vein wall elasticity with failure of the valve leaflets
- An increase in venous filling pressure is sufficient to promote varicose remodeling of veins by augmenting wall stress and activating venous endothelial and smooth muscle cells.
Autosomal dominant with incomplete penetrance
- Increasing age
- Pregnancy, especially multiple pregnancies
- Prolonged standing
- History of phlebitis (postthrombotic syndrome)
- Family history
- Female sex
- Increased height
- Congenital valvular dysfunction
Commonly Associated Conditions
- Stasis dermatitis
- Large varicose veins may lead to skin changes and eventual stasis ulceration.