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18 - Varicose veins and chronic venous insufficiency
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- By Marcus Cleanthis, Freeman Hospital, UK, Tim Lees, Freeman Hospital, UK
- Edited by Vish Bhattacharya, Gerard Stansby
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- Book:
- Postgraduate Vascular Surgery
- Published online:
- 03 May 2011
- Print publication:
- 20 January 2011, pp 204-219
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- Chapter
- Export citation
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Summary
Key points
Truncal varices are common with an age-adjusted prevalence of 40% in men and 32% in women
Varicosities may be primary or secondary due to previous deep vein thrombosis (DVT), pelvic obstruction or deep venous reflux
Patients present with discomfort, swelling, pain, pruritis, bleeding, thrombophlebitis and skin changes
Hand held Doppler has replaced the tourniquet test as a ‘bedside examination’ for evaluating incompetence of valves
Current treatments for varicose veins include conventional surgery, radiofrequency ablation, laser ablation and injection sclerotherapy (liquid or foam)
Surgery to the great saphenous vein involves high tie and stripping and has a recurrence rate of 15%–20%
Surgery to the small saphenous vein involves saphenopopliteal ligation, stripping and phlebectomy
Foam sclerotherapy and catheter ablation techniques using laser or radiofrequency can be used under local anaesthesia, but less is known about their long-term outcome
Chronic venous insufficiency affects between 7% and 9% of the adult population and is due to venous reflux, obstruction or calf pump failure
Clinical signs include swelling, venous eczema, pigmentation lipodermatosclerosis and ulceration
Multilayered compression is the gold standard used to heal venous ulceration
The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial showed a reduced ulcer recurrence rate with combined surgery and compression
Venous reconstruction is rarely performed and usually reserved for severe disease, resistant to other forms of treatment
Varicose veins
Epidemiology
Data from the Edinburgh Vein Study suggest a slightly greater prevalence of varicose veins in males compared to females (4 : 3.2).