Vascular Surgery

Varicose Veins

Varicose veins are superficial veins made tortuous by venous reflux; symptoms, skin change, ulceration, bleeding or thrombosis determine referral, with duplex-guided intervention preferred over routine compression hosiery when treatment is suitable.

Definition

Varicose veins are dilated, tortuous superficial leg veins caused by venous valve incompetence and reflux. They may be asymptomatic, but symptoms, skin changes, ulceration, bleeding or thrombosis indicate clinically important disease.

First principles

Venous return depends on valves and the calf pump

Leg veins return blood against gravity through competent valves, the calf-muscle pump and unobstructed deep venous channels. When superficial or deep valves become incompetent, blood refluxes and pools during standing, increasing venous pressure and stretching the vein into a visible tortuous varicosity.

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