Description

• Superficial venous disease causing a permanent dilatation and tortuosity of superficial veins, usually occurring in the legs and feet; caused by systemic weakness in the vein wall, and may result from congenitally incomplete valves or valves that have become incompetent
• Affects legs where reverse flow occurs when dependent
• Truncal varices involve the great and small saphenous veins; branch varicosities involve the saphenous vein tributaries.
• Categorized as (1):
  • Uncomplicated (cosmetic)
  • With local symptoms (pain confined to the varices, not diffuse)
  • With local complications (superficial thrombophlebitis, may rupture causing bleeding)
  • Complex varicose disease (diffuse limb pain, swelling, skin changes/ulcer)
• System(s) affected: Cardiovascular; Skin

ALERT
Ulceration of varicose veins has a high rate of infection, which can lead to sepsis.

• Common; usually valvular degeneration, but may be secondary to chronic venous deficiency
• Elastic support hose and frequent rests with legs elevated rather than ligation and stripping

• Frequent problem
• Elastic stockings are recommended for those with a history of varicosities or if a great deal of standing is involved.

Epidemiology

• Predominant age: Middle age
• Predominant gender: Female > Male (5:1)
• National Women's Health Information Center estimates that 50% of women have varicose veins.

Risk Factors

• Increasing age
• Pregnancy, especially multiple pregnancies
• Occupations that require prolonged standing, restrictive clothing (e.g., very tight girdles)
• Obesity
• History of phlebitis
• Family history

Genetics
Familial, dominant, X-linked

Pathophysiology

• Varicose veins are caused by venous insufficiency from faulty valves in ≥1 perforator veins in the lower leg, causing secondary incompetence at the saphenofemoral junction (valvular reflux).
• Valvular dysfunction causing venous reflux and subsequently venous hypertension (HTN)
• Failed valves allow blood to flow in the reverse direction (away from the heart), from deep to superficial and from proximal to distal veins.
• Deep thrombophlebitis
• Increased venous pressure from any cause
• Congenital valvular incompetence
• Trauma (consider arteriovenous fistula; listen for bruit)
• Presumed to be due to a loss in vein wall elasticity with failure of the valve leaflets

Commonly Associated Conditions

• Stasis dermatitis
• Large varicose veins may lead to skin changes and eventual stasis ulceration.