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Varicose Veins

These are defined as tortuous dilated veins. They affect 5% or more of the adult population of western countries. The gender prevalence was found to be nearly equal in the recent Edinburgh Vein Study. There is often a clear family history of the disorder, with some patients inheriting abnormalities in the FOXC2 gene. The pathophysiology of varicose vein development is probably
related to defective connective tissue and smooth muscle in the vein wall leading to a secondary incompetence of the valves rather than to a primary defect in the valves, which occurs in a small group of patients who have total venous avalvulosis. Varicose veins may develop secondarily in patients with postthrombotic limbs and in patients with congenital abnormalities such as the Klippel–Trenaunay syndrome or multiple arteriovenous fistulae. Pregnancy and pelvic tumours are also wellrecognised predisposing factors. Some of the other factors that may predispose to the development of varicose veins are:
• age;
• sex;
• race;
• weight;
• height;
• diet;
• side (left > right);
• bowel habit;
• occupation;
• heredity;
• clothes;
• erect stance.

Clinical features

Varicose veins rarely cause severe symptoms. Aching in the veins at the end of the day, after prolonged standing, is the most common complaint of patients referred to hospital, but many patients with severe varicose veins never consult a doctor. Other symptoms include ankle swelling, itching, bleeding, superficial thrombophlebitis, eczema, lipodermatosclerosis and ulceration.All of these symptoms are rare and it is not known why some patients with primary varicose veins develop the important complications of eczema, lipodermatosclerosis and ulceration.Tortuous dilated veins in the subcutaneous tissue are indicative of varicose veins. Most develop in the tributaries of the greater and lesser saphenous veins, which are usually dilated but rarely varicose themselves. Varicosities in the thigh are indicative of long saphenous incompetence, whereas varicosities on the back of the leg are suggestive of short saphenous incompetence. Some varicose veins join both systems and it is important to examine both the greater and lesser saphenous veins
for the presence of valvular incompetence. Smaller varicosities are called reticular veins and are of dubious significance; the presence of these and thread veins within the skin is not necessarily associated with major varicose veins and is purely cosmetic.
The Edinburgh Vein Study failed to show any evidence that the extent of valvular incompetence was related to the presence of symptoms.

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