Subcutaneous, permanently dilated veins 3 mm or more in diameter when measured in a standing position
Increasing numbers of births
Veins are smaller in size (<1 mm). No evidence of reflux on duplex examination
Veins range between 1 mm and 3 mm in diameter. No evidence of reflux on duplex examination
Prevalence rates are higher in industrialised countries and in more developed regions
Prevalence of varicose veins increases with age
A genetic link exists, and the risk of varicose veins developing if both parents are affected is 90%; 62% risk if 1 parent is affected and female offspring; 25% risk if 1 parent is affected and male offspring; and if no parent is affected, the risk is 20%
The exact primary cause of varicose veins remains elusive
Valve incompetence is the most common aetiology
Blood pools when valves do not function properly, leading to increased pressure and distension of the veins
Progesterone is believed to lead to passive venous dilation, which may then lead to valvular dysfunction.
Oestrogen produces collagen fibre changes and smooth muscle relaxation, which both lead to vein dilation
presence of risk factors
dilated tortuous veins
leg fatigue or aching with prolonged standing
bleeding from varices
bleeding from varices
Veins are thin-walled and lack the muscular walls of arteries
Therefore, veins require assistance in blood return.
This is provided by valves and muscle pumps.
When one of these factors is not functioning properly, venous hypertension and insufficiency can ensue, possibly leading to varicose veins
A normal vein wall has 3 smooth muscle layers that all help to maintain vein tone.
Varicose veins demonstrate marked proliferation of collagen matrix as well as decreased elastin leading to distortion and disruption of muscle fibre layers
Reflux is defined as valve closure >0.5 second.
For best sensitivity, reverse flow, or reflux, should be measured with the patient standing and with the leg in external rotation.
With duplex ultrasound, specific segments affected by reflux can be delineated as superfical and deep truncal veins, perforators, and tributaries can all be visualised.
Reflux in the great saphenous vein or common femoral vein can be detected through use of a Valsalva manoeuvre
More distal reflux can be elicited by compressing the leg above the Doppler to see if blood is forced back towards the feet.
If a great saphenous vein is >6 mm in diameter, reflux is likely to be present.
However, reflux in a perforator vein <4 mm in diameter is not considered significant.
Duplex ultrasound can be performed not only to assess for valve closure time but also to rule out deep vein thrombosi