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).