Patient will present as → 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
- Varicose veins are typically asymptomatic but may cause a sense of fullness, pressure, pain with exertion, and pain or hyperesthesia in the legs
Varicose veins can usually be diagnosed by physical examination - a visual inspection of the leg in a dependent position usually confirms the presence of varicosities
- Venous duplex ultrasound examination confirms the diagnosis (and identifies the cause), demonstrating the presence of venous reflux (>500 milliseconds for superficial or perforator veins; >1000 milliseconds for deep veins)
Treatment may include compression stockings, sclerotherapy, minimally invasive surgery, or thermal ablation
- Regardless of treatment, varicose veins often recur
Osmosis | |
Varicose veins are dilated subcutaneous veins that may be small and harmless or large and bulging. Varicose veins are caused by increased venous pressure and incompetent valves. They typically occur in the legs but may also occur in the esophagus, vulva, anorectal area, and spermatic cord (varicocele). Assessment findings include telangiectasias (spider veins), small reticular veins, and dilated and tortuous veins.
Play Video + QuizVaricose Veins Interventions
Varicose veins are dilated subcutaneous veins that may be small and harmless or large and bulging. Other types of varicosities include reticular veins and spider veins (telangiectasias). Varicose veins are caused by increased venous pressure and incompetent vein valves. They typically occur in the legs but may also occur in esophagus, vulva, anorectal area, and spermatic cord (varicocele). Interventions include laser therapy, sclerotherapy, or surgical removal of the saphenous vein. To prevent worsening conditions, the patient should be taught to avoid prolonged standing, and to wear elastic compression stockings.
Question 1 |
Pain in the calf with ambulation Hint: 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 Hint: Stasis Dermatitis and edema are most suggestive of chronic venous insufficiency. | |
Edema in the lower extremities Hint: See C for explanation. |
Question 2 |
deep venous thrombosis Hint: 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 Hint: Lymphedema is a condition also associated with calf heaviness and edema but the symptoms do not resolve spontaneously. | |
varicose veins | |
intermittent claudication Hint: Intermittent claudication is not associated with peripheral edema generally and while the pain is resolved with rest, walking exacerbates the pain. |
List |
References: Merck Manual · UpToDate