Varicose Veins

Dilated, tortuous superficial veins with incompetent venous valves.

Moderate to large varicose veins are common among the elderly. Varicose veins are often primary (affecting only the superficial veins) but may be secondary (due to disorders such as chronic venous insufficiency, which affects deep veins). Primary varicose veins result from primary valvular degeneration, which is often hereditary.

Symptoms and Diagnosis

Varicose veins, overfilled with blood, bulge and become visible, and their capillaries form a network of spider veins, accompanied by purple discoloration. Common sites are the medial thigh and leg and the area behind the knee. Hemorrhoids are a form of varicose veins. Varicose veins occasionally ache or throb. The legs may feel heavy or hot, or they may itch. Severity of symptoms does not necessarily relate to size or severity of the varicosities. Symptoms are worse when standing.

Varicose veins are usually diagnosed by inspection, but their extent can be determined only by palpation with the patient standing.

A tourniquet test can help distinguish primary from secondary varicose veins. When the deep and communicating veins are competent (as occurs with primary varicose veins), compression of the superficial veins by a tourniquet placed above the knee impedes retrograde filling. When the deep veins are totally competent, complete venous filling after tourniquet application requires at least 45 seconds. (Without a tourniquet, all varicose veins would fill rapidly in retrograde fashion.) Primary varicose veins produce no signs of stasis and no evidence of deep and communicating vein incompetence during the test. However, when the deep and communicating veins are incompetent (as occurs with secondary varicose veins), blood flows in a retrograde fashion below the tourniquet and then rapidly fills the superficial veins through the communicating veins.

Treatment

For primary varicose veins, elastic support is the only treatment necessary. The disorder is not dangerous, although it may lead to superficial thrombophlebitis and the veins may bleed easily if traumatized. Venous ligation and stripping have almost no role in the treatment of the elderly. Surgery for primary varicose veins is only cosmetic, and recurrence is common.

For secondary varicose veins, the cause rather than the varicose veins must be treated. If the cause is chronic venous insufficiency, stripping is useless because the pathogenesis of venous insufficiency is related to hypertension in the deep venous system.