- Are tortuous dilated superficial veins
- Are different to reticular veins or telangiectasia
- Are caused by weak vein walls causing dilation and valve incompetence
- Are often symptomless
- Are investigated with Doppler venous scanning.
- Can be left untreated, compressed, injected or operated on
- Often recur
Epidemiology and Aeitiology
- Affect 40% of men and 32% of women
- However, a higher proportion of women present with varicose veins, possibly due to the cosmetic effect veins have, or because they appear earlier than in males
- ↑ No. of pregnancies
Long periods of standing – e.g. occupation as a teacher, shop assistant, surgeon(!) etc
- Family History
- The presence of valves, which prevent back-flow of blood distally
- The deep venous system is assisted by pressures generated by muscles, noticeably the calf muscles.
In the case of varicose veins it is the former of these two mechanisms that is usually the problem. It used to be thought that valve incompetence, resulting in blood pooling/stasis was the cause of the dilated vein, however that hypothesis has become out of favour, and the current thinking is that weakness in the vein wall causes dilation of the vein. If this occurs around a valve, then the cusps of the valve will no longer meet in the middle and the valve will become incompetent, resulting in backflow of blood, and therefore inadequate drainage. The most common valves involved are those around the saphenofemoral junction (in the groin), however they can occur in other places for example the junction between the short saphenous vein and the popliteal vein.
History and examination