Patient will present with → a 77-year-old Hispanic female with a dull ache in her legs that is worsened with prolonged standing and relieved with rest and elevation of her legs. She has 14 grown children and a past medical history of obesity and hypertension. On physical exam, her bilateral lower legs are edematous with multiple dilated, tortuous superficial veins.
Varicose veins are dilated superficial veins in the lower extremities. Usually, no cause is obvious.
- Approximately 15% of adults, particularly women who have been pregnant, develop varicosities.
- Other risk factors include obesity, family history, prolonged sitting or standing, and history of phlebitis.
- The main mechanisms are superficial venous insufficiency and valvular incompetence; inherited defects in vein walls or valves also play a role.
- Dilated, tortuous veins develop superficially in the lower extremities, particularly in the distribution of the great saphenous vein. Smaller blue-green, flat reticular veins; telangiectasias; and spider veins are further evidence of venous dysfunction.
- Varicosities may be asymptomatic or associated with aching and fatigue.
- Chronic distal edema, abnormal pigmentation, fibrosis, atrophy, and skin ulceration may develop in severe or prolonged disease.
Diagnosis is clinical - visual inspection of the leg in dependent position usually confirms the presence of varicosities.
- Duplex ultrasonography locates incompetent valves/ venous reflux before surgery. In most cases, reflux arises from the greater saphenous vein.
Graduated compression stockings provide external support.
- Leg elevation and regular exercise provide symptomatic relief.
- Small venous ulcers heal with leg elevation and compression bandages; larger ulcers may require compression boot dressing (Unna boot) or skin grafts.
- Interventional techniques include endovenous radiofrequency or laser ablation, compression sclerotherapy, and sometimes surgical stripping of the saphenous tree.
Pain in the calf with ambulation
Patients with deep venous thrombosis (DVT) may present with complaints of pain in the calf with ambulation. Secondary varicosities may result from DVT's.
Dull aching heaviness brought on by periods of standing
Brownish pigmentation above the ankle
Stasis Dermatitis and edema are most suggestive of chronic venous insufficiency.
Edema in the lower extremities
See C for explanation.
deep venous thrombosis
Deep venous thrombosis edema is usually unilateral, may be associated with calf tenderness or a palpable cord, and does not resolve on its own.
Lymphedema is a condition also associated with calf heaviness and edema but the symptoms do not resolve spontaneously.
Intermittent claudication is not associated with peripheral edema generally and while the pain is resolved with rest, walking exacerbates the pain.