Definition:

Varicose veins are normal veins that have dilated because of increased venous pressure and are visible on the surface of skin as a syndrome of venous insufficiency (altered flow of blood through veins to allow blood to pool in areas).  Venous insufficiency symptoms can range from mild discomfort or cosmetic alterations to loss of a limb or life.  New varicose veins can be seen as an episode of a deep vein thrombosis/clot (DVT).  Chronic venous insufficiency can also produce skin and tissue changes starting with mild swelling and progressing to discoloration, dermatitis, cellulitis, ulceration, and phlebitis.  Risk factors include: increased age, inborn weakness of vein walls (hereditary), prolonged standing, female gender, pregnancy.  

Symptoms:

• Pain
• Soreness
• Burning
• Aching
• Throbbing
• Cramping
• Muscle fatigue
• "Restless legs"

Diagnosis:

• Imaging the anatomy of the veins (contrast venography, MRI, color-flow duplex ultrasound)
  • Duplex ultrasound - standard modality
  • 2-D ultrasound - better for deep structures
  • Color-flow ultrasound - detection of blood flow through veins
• MRV - for deep/superficial veins in lower pegs and pelvis
• Direct contrast venogram - more invasive with complication risks
• Venous refilling time - to measure time for blood to refill a limb after emptied
• Maximum Venous Outflow - detects obstruction in veins
• Calf Muscle Pump Ejection Fraction - detect failure of veins to pump blood out of calfs

Treatment:

• Sclerotherapy - injection of substance (Polidocanol or sodium tetradecyl sulfate)into abnormal vessels to destroy inner vein lining and forms fibrotic cord
• Laser Ablation - laser fiber inside vein to destroy vein inner lining
• Radiofrequency Ablation - catheter placed inside vein to heat vessel wall causing immediate closure of vessel
• Surgical extirpation - removal of short segments of veings through tiny incisions