Varicose veins are dilated superficial veins commonly found on the lower limbs.
Though often asymptomatic they may cause distressing symptoms and cause cosmetic upset. They are common, and prevalence increases with age and in pregnancy.
Varicose veins develop due to increased pressure in small superficial veins.
In healthy veins, a one way system back to the heart is maintained by valves. This also protects small superficial veins from the increased pressures experienced within the deep compartments of the leg.
Venous insufficiency may occur due to valvular incompetence resulting in raised pressures in the superficial veins and the development of varicosities.
Varicose veins increase with age and in multiparous women.
Varicose veins are frequently asymptomatic beyond their cosmetic appearance but they may cause debilitating symptoms.
The imaging of choice in varicose veins is duplex US.
Duplex US: Patients requiring referral to vascular surgery should undergo US. It demonstrates venous reflux, and allows mapping and surgical planning.
Some patients will require referral to vascular surgery for consideration of interventional techniques.
The following patients should be referred to vascular surgery. Clinical judgement can be used for those not fitting the below criteria.
Management may be divided into conservative and interventional techniques.
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