Lower limb varicose veins: causes, symptoms, diagnosis, treatment

Varicose veins of the lower extremities are dilations of the superficial veins of the lower extremities. There is usually no obvious cause. Varicose veins are usually asymptomatic, but a feeling of fullness, pressure, and pain or hyperesthesia in the legs may occur. Diagnosis is made by physical examination. Treatment for varicose veins of the lower extremities includes compression, injury prevention, sclerotherapy, and surgery.

This disease occurs in isolation or in combination with chronic venous insufficiency.

Causes of varicose veins of the lower extremities

The cause is usually unknown, but varicose veins may result from primary venous valvular insufficiency with reflux or primary dilation of the vein walls due to weakness of the vascular wall. In some people, varicose veins result from chronic venous insufficiency and venous hypertension. Most people have no obvious risk factors. Varicose veins often run in families, suggesting a hereditary component. Varicose veins are more common in women because estrogens negatively affect the vascular wall, and pregnancy increases venous pressure in the veins of the pelvis and lower extremities. Varicose veins are sometimes part of the Klippel-Trenaunay-Weber syndrome, which includes congenital arteriovenous fistulas and widespread cutaneous capillary angiomas.

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Symptoms of varicose veins of the lower extremities

Varicose veins may initially be tense and palpable but not necessarily visible. Later, they may progressively enlarge, protrude, and become visible. This condition may cause a feeling of fullness, fatigue, pressure, and superficial pain or hyperesthesia in the legs. Varicose veins become more visible when the patient is standing. For unclear reasons, stasis dermatitis and venous varicose ulcers are rare. When skin changes (eg, induration, pigmentation, eczema) occur, they are typically localized to the medial malleolus. Ulcers may develop after minimal trauma and are usually small, superficial, and painful. Varicose veins sometimes thrombose, causing pain. Superficial varicose veins may form thin venous bullae in the skin that may rupture and bleed after minimal trauma. Very rarely, such bleeding, which occurs in a dream and is not detected in time, becomes fatal.

Diagnosis of varicose veins of the lower extremities

The diagnosis is usually obvious on physical examination. The Trendelenburg test (comparison of venous filling before and after application of a tourniquet to the thigh) is no longer commonly used to detect backflow through defective saphenous vein valves because the sensitivity, specificity, and variability of results for this test have not been determined.

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Treatment of varicose veins of the lower extremities

Treatment is aimed at reducing symptoms, improving the appearance of the leg, and in some cases preventing complications. Treatment includes compression stockings and injury prevention.

Injection sclerotherapy and surgical treatment are indicated for prevention of recurrent thrombosis and for skin changes. These procedures are also commonly used for cosmetic reasons. Sclerotherapy uses an irritant (eg, sodium tetradecyl sulfate) to induce thrombophlebitis, leading to fibrosis and occlusion of the vein; however, in many cases, varicose veins become patent. Surgical treatment involves ligation or excision of the great and (sometimes) small saphenous veins of the lower extremity. These procedures provide temporary symptom relief, but long-term efficacy is poor.

Regardless of treatment, new varicose veins develop, and treatment is often carried out continuously.