Varicose Vein: Current Management

Chronic venous insufficiency can be found in 15% to 20% of the population. The prevalence goes up to 50% if small telangiectasias are included [1]. Venous ulcers are observed in 2% of patients with chronic venous insufficiency, and the treatments of these ulcers alone carry a significant cost [2]. Several risk factors for the development of varicose veins have been identified, which include age, female gender, multiparity, family history, obesity, and job activities that involve prolonged standing. Obesity seems to be a risk factor only in women but not in men. Exercise activity seems to be protective in men but not in women. In at least one study, however, trunk varices were observed to be more prevalent in men [1]. ETIOLOGY The etiology of chronic venous insufficiency is believed to involve one or a combination of the following: venous obstruction, valvular insufficiency, and calf muscle pump dysfunction. Valvular insufficiency is the most common cause, and most valvular insufficiency cases involve the superficial veins of the lower extremity. Deep vein thrombosis (DVT) is a primary cause of valvular insufficiency and obstruction in the deep system. Calf muscle pump dysfunction leads to the inability of the blood column to properly exit the lower extremity. Similar to all are stasis and persistent venous hypertension, which eventually result in the sequelae of chronic venous insufficiency [2]. SIGNS, SYMPTOMS, EVALUATION, AND TREATMENT Common complaints of patients with chronic venous disease include pain, swelling, leg heaviness or throbbing, itching, and cramps. Skin changes (hyperpigmentation, eczema, lipodermatosclerosis, or atrophie blanche) and ulcer formation are seen in more advanced presentations of the disease. Varicose veins are defined as dilated (>3 mm) subcutaneous veins that are visible and palpable. These veins can elongate and have significant tortuosity. Varicose veins can be trunk varices or those limited to branches [2,3]. The evaluation of a patient with chronic venous disease should incorporate the CEAP classification, which classifies the patient’s disease severity based on