Varicose veins - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Varicose veins are very common, affecting up to 40% of the population, but not all are symptomatic.
Clinical presentation includes lower extremity pain, fatigue, itching and/or heaviness, which often worsen with prolonged standing, associated with dilated tortuous veins.
Varicose veins can lead to significant quality of life impairment in affected individuals.
Underlying venous insufficiency can be documented by duplex ultrasound.
Treatment options for symptomatic varicose veins include endovenous thermal ablation, foam sclerotherapy, and open surgery.

Varicose veins

From the collection of Maureen K. Sheehan, MD; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Kakkos SK, Gohel M, Baekgaard N, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021 Jan;61(1):9-82.[Abstract][Full Text]
Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex scanning and treatment of superficial truncal reflux: endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2023 Mar;11(2):231-261.e6.[Abstract]
National Institute for Health and Care Excellence. Varicose veins: diagnosis and management. July 2013 [internet publication].[Full Text]
De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022 Feb;63(2):184-267.[Abstract][Full Text]
van der Velden SK, Biemans AA, De Maeseneer MG, et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 2015 Sep;102(10):1184-94.[Abstract]
Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med. 2019 Sep 5;381(10):912-22.[Abstract]
Gohel MS, Heatley F, Liu X, et al. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med. 2018 May 31;378(22):2105-14.[Abstract][Full Text]
Brittenden J, Cotton SC, Elders A, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014 Sep 25;371(13):1218-27.[Abstract][Full Text]

Referenced Articles

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17. National Institute for Health and Care Excellence. Varicose veins: diagnosis and management. July 2013 [internet publication].[Full Text]
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30. Shepherd AC, Gohel MS, Brown LC, et al. Randomized clinical trial of VNUS ClosureFAST radiofrequency ablation versus laser for varicose veins. Br J Surg. 2010 Jun;97(6):810-8.[Abstract][Full Text]
31. Kabnick LS, Sadek M. Fiber type as compared to wavelength may contribute more to improving postoperative recovery following endovenous laser ablation. J Vasc Surg Venous Lymphat Disord. 2016 Jul;4(3):286-92.[Abstract]
32. Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med. 2019 Sep 5;381(10):912-22.[Abstract]
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44. Rasmussen LH, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug;98(8):1079-87.[Abstract]
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46. Bootun R, Lane TR, Davies AH. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology. 2016 Feb;31(1):5-14.[Abstract]
47. Vähäaho S, Mahmoud O, Halmesmäki K, et al. Randomized clinical trial of mechanochemical and endovenous thermal ablation of great saphenous varicose veins. Br J Surg. 2019 Apr;106(5):548-54.[Abstract]
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