Varicose veins

Last revised by Ayush Goel on 30 Apr 2023

Varicose veins are dilated tortuous superficially located venous channels that accompany the superficial veins of the upper or lower limbs.

Varicose veins are more common in women than men and are more common in the lower limb than in the upper limb 5. Risk factors include:

  • pregnancy
  • older age
  • female gender
  • prolonged standing

Incompetent saphenofemoral junction, which itself results from saphenofemoral valve insufficiency, is a well-known cause. It leads to regurgitation of blood during expiration and consequently raises the venous pressure in the great saphenous and other superficial veins.

Incompetent perforators are another causative factor when destruction of the valves inside the perforators allow the blood to move from the deep to superficial system (reverse direction) and consequently increases the superficial venous pressure.

Varicose veins may appear as dilated tortuous subcutaneous opacities.

Doppler ultrasound can detect the presence and distribution of subcutaneous varicosities. Moreover, it is the method of choice to assess the state of the saphenofemoral junction. Reflux of blood flow at the junction during Valsalva maneuvre indicates incompetence. Reflux that lasts for more than 1 second is significant and usually require surgical intervention. Reflux that lasts 0.5-1 second is insignificant and usually requires conservative management. Incompetent perforators are assessed in the standing position.

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