Makindo Medical Notes

Varicose veins are enlarged, tortuous, dilated veins of the lower limbs caused by venous insufficiency. They result from valve incompetence and pooling of blood. While often cosmetic, they can cause discomfort and serious complications if untreated. The great saphenous vein (GSV) is most commonly involved.

⚠️ Causes & Risk Factors

• 📈 Age: Vein wall elasticity declines with age.
• ♀️ Gender: Hormonal effects (pregnancy, menopause, OCP use) increase risk in women.
• 🤰 Pregnancy: Raised blood volume & pelvic vein compression predispose.
• 🧍 Prolonged Standing/Sitting: Impairs venous return (e.g., nurses, hairdressers).
• ⚖️ Obesity: Extra weight → increased venous pressure.
• 👨‍👩‍👧 Family History: Genetic predisposition.
• 🩺 Previous DVT: Valve damage → chronic insufficiency.

🔬 Pathophysiology

• Valve incompetence → retrograde flow (reflux).
• ↑ Venous pressure → pooling, wall stretching, tortuosity.
• Superficial system (esp. GSV) usually affected; deep system preserved until advanced disease.

👀 Clinical Features

• 👁️ Visible veins: Dilated, twisted, bluish veins.
• 🦵 Leg heaviness/aching: Worse with standing, relieved by elevation.
• 💧 Swelling: Ankles/lower legs (esp. evenings).
• 🔥 Itching/Burning: Perivenous irritation.
• 🌙 Night cramps: Common complaint.
• 🎨 Skin changes: Hyperpigmentation, eczema, lipodermatosclerosis, venous ulcers (gaiter area).

🚨 Complications

• 🩹 Superficial thrombophlebitis: Painful, red, tender cord.
• 🦶 Venous ulcers: Typically around medial malleolus.
• 💉 Bleeding: From superficial, fragile veins.
• 🧴 Chronic Venous Insufficiency: Skin fibrosis, stasis eczema, atrophie blanche.

🧪 Diagnosis

• 👨‍⚕️ Clinical exam: Look for dilated veins, skin changes, ulcers.
• 🩻 Doppler ultrasound: Gold standard → detects reflux, obstruction.
• 📊 Plethysmography: Non-invasive venous function test (rarely needed).

🩺 Conservative Management

• 🧦 Compression stockings: First-line for symptom relief.
• 🛏️ Leg elevation: Reduces venous pressure & oedema.
• ⚖️ Weight loss: Improves venous return.
• 🚶 Exercise: Walking activates calf pump.
• ⏳ Avoid prolonged standing/sitting: Encourage mobility & calf raises.

🔧 Interventional Treatments

• 💉 Sclerotherapy: Injection of sclerosant for small veins/spider veins.
• 🔦 Endovenous Laser Ablation (EVLA): Catheter + laser → thermal vein closure.
• 📡 Radiofrequency Ablation (RFA): Alternative to EVLA using RF energy.
• ✂️ Ambulatory Phlebectomy: Small incisions to remove veins.
• 🩺 Vein Stripping & Ligation: More invasive, used in extensive disease.

🛡️ Prevention

• 🏃 Exercise regularly (calf strengthening).
• ⚖️ Maintain healthy BMI.
• 🧍‍♂️ Avoid prolonged standing/sitting → move often, flex ankles.
• 🧦 Compression stockings in high-risk groups.
• 🛏️ Elevate legs when resting.

📌 Conclusion

Varicose veins are common and usually benign, but they can cause pain, skin changes, and ulcers.
✅ Early recognition & lifestyle measures reduce progression. ✅ Compression therapy is first-line. ✅ Minimally invasive techniques (EVLA/RFA/sclerotherapy) are now preferred over open surgery.

Exam Tip: Always mention complications (ulcer, thrombophlebitis, bleeding) and Doppler as the key diagnostic tool in OSCEs. 🚑