Varicose veins (VVs)

Varicose veins are dilated, tortuous veins in the leg.

Most varicose veins are primary; the remainder are secondary to other disorders such as deep venous thrombosis or pelvic occlusion.

Varicose veins occur in young adults and incidence increases with age to 80% at 60 years. Women are affected more frequently than men.

Varicose veins are asymptomatic in the majority of people, yet remain one of the most common reasons for surgical referral in the developed world.

Prominent varicosities usually develop slowly, over a period of 10-20 years. In most cases, the process begins in the groin with failure of the sapheno-femoral valve.

The long saphenous system is involved in 90% of cases; the short system, in 10%.

In some people varicose veins are asymptomatic or cause only mild symptoms, but in others they cause pain, aching or itching and can have a significant effect on their quality of life

• varicose veins may become more severe over time and can lead to complications such as changes in skin pigmentation, bleeding or venous ulceration
• not known which people will develop more severe disease but it is estimated that 3-6% of people who have varicose veins in their lifetime will develop venous ulcers.

Referral from primary care with varicose veins:

• Refer people to a vascular service if they have any of the following:
  • with bleeding varicose veins - requires immediate referral to a vascular service
    
    
  • symptomatic* primary or symptomatic* recurrent varicose veins
    
    
  • lower-limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency
    
    
  • superficial vein thrombosis (characterised by the appearance of hard, painful veins) and suspected venous incompetence
    
    
  • a venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks)
    
    
  • a healed venous leg ulcer

* veins found in association with troublesome lower limb symptoms (typically pain, aching, discomfort, swelling, heaviness and itching)

Reference:

• 1) NICE (July 2013). Varicose veins in the legs - The diagnosis and management of varicose veins