Varicose veins

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Alternative names
Varicosity; Varicosis

Definition
Varicose veins are enlarged, twisted, painful superficial veins resulting from poorly functioning valves.

Causes, incidence, and risk factors

In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain in the vein. Pooling of blood in a vein causes it to enlarge.

This process usually occurs in the veins of the legs, although it may occur elsewhere. Varicose veins are common, affecting mostly women.

Causes include congenitally defective valves, thrombophlebitis, and pregnancy. Prolonged standing and increased pressure within the abdomen may increase susceptibility to the development of varicose veins or aggravate the condition.

Primary varicose veins occur because of congenitally defective valves, or without a known cause. Secondary varicose veins occur because of another condition, such as occurs when a pregnant woman develops varicose veins.

Symptoms

• Pain in the legs: fullness, heaviness, aching
  
• Visible, enlarged veins
  
• Mild swelling of ankles
  
• Skin at the ankle discolored brown
  
• Skin ulcers near the ankle

Signs and tests
The diagnosis is based primarily on the characteristic appearance of the legs when the patient is standing or is seated with the legs dangling. At times a physician may order a duplex ultrasound exam of extremity to see blood flow and characterize the vessels, and to rule out other disorders of the legs. Rarely, an angiography of the legs may be performed to rule out other disorders.

Treatment

Treatment is usually conservative. The patient will be asked to avoid excess standing, elevate the legs when resting or sleeping, and to wear elastic support hose.

Treatment may be requested to improve the appearance. Surgery such as vein stripping and ligation (removal of the varicose vein), or sclerotherapy of veins (injecting with a solution that causes scarring, which closes the vein) may be recommended. Vein stripping is a very extensive procedure, and it is usually reserved for patients who are experiencing a lot of pain or who have skin ulcers.

Expectations (prognosis)
Varicose veins tend to worsen over time. Discomfort and progression may be lessened with self care.

Complications

• Phlebitis (chronic inflammation of the vein)
  
• Formation of leg ulcers
  
• Rupture of a varicose vein

Calling your health care provider
Call for an appointment with your health care provider if varicose veins are painful, or if they worsen or do not improve with self treatment, such as keeping legs elevated or avoiding excessive standing.

Also call if complications occur, including a sudden increase in pain or swelling, fever, redness of the leg, or the development of leg ulcers.

Prevention
Avoid prolonged standing if personal or family history indicates you are at risk of developing varicose veins.

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