Varicose veins

Clinic

• Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted
• However, some individuals may experience fatigue or pain in the area.

Special locations

• Varices in the scrotum are known as a varicocele
• Around the anus are known as hemorrhoids.

Varicose vs spider veins

Spider veins affect the capillaries and are smaller.

Signs and symptoms

• Aching, heavy legs
• Appearance of spider veins (telangiectasia) in the affected leg
• Ankle swelling
• A brownish-yellow shiny skin discoloration near the affected veins
• Redness, dryness, and itchiness of areas of skin, termed stasis dermatitis or venous eczema
• Muscle cramps when making sudden movements, such as standing
• Abnormal bleeding or healing time for injuries in the affected area
• Lipodermatosclerosis or shrinking skin near the ankles
• Restless legs syndrome appears to be a common overlapping clinical syndrome in people with varicose veins and other chronic venous insufficiency
• Atrophie blanche, or white, scar-like formations
• Burning or throbbing sensation in the legs

People with varicose veins might have a positive D-dimer blood test result due to chronic low-level thrombosis within dilated veins (varices).

Complications

• Pain, tenderness, heaviness, inability to walk or stand for long hours
• Skin conditions / dermatitis which could predispose skin loss
• Skin ulcers / Venous ulcers
• Carcinoma or sarcoma (0.4-1%)
• Severe bleeding from minor trauma, of particular concern in the elderly
• Blood clotting within affected veins, termed superficial thrombophlebitis.
• Acute fat necrosis: Females have a higher tendency of being affected than males

Causes

• Mechanical: Pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining, Venous and arteriovenous malformations.
• Phlebitic obstruction or incontinence

• Venous reflux is a significant cause

• Hyperhomocysteinemia

CEAP Stages

CEAP: Clinical, Etiological, Anatomical, and Pathophysiological

• C0 – no visible or palpable signs of venous disease
• C1 – telangectasia or reticular veins
• C2 – varicose veins
• C2r - recurrent varicose veins
• C3 – edema
• C4- changes in skin and subcutaneous tissue due to Chronic Venous Disease
• C4a – pigmentation or eczema
• C4b – lipodermatosclerosis or atrophie blanche
• C4c- Corona phlebectatica
• C5 – healed venous ulcer
• C6 – active venous ulcer
• C6r- recurrent active ulcer

Each clinical class is further characterized by a subscript depending upon whether the patient is symptomatic (S) or asymptomatic (A), e.g. C2S.