Varicose veins


    • Subcutaneous, permanently dilated veins 3 mm or more in diameter when measured in a standing position

Risk Factors

    • increasing age

    • FHx

    • Female gender

    • Increasing numbers of births

    • DVT

    • Prolonged standing

    • Obesity

Differential diagnosis

    • Telangiectasias

      • Veins are smaller in size (<1 mm). No evidence of reflux on duplex examination

    • Reticular veins

      • 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

Clinical features

    • presence of risk factors

    • dilated tortuous veins

    • leg fatigue or aching with prolonged standing

    • leg cramps

    • restless legs

    • itching

    • bleeding from varices

    • haemosiderin deposition

    • corona phlebectatica

    • lipodermatosclerosis

    • ankle swelling

    • ulceration

    • 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


    • Duplex ultrasound

      • 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


a) conservative

b) medical

c) surgical