![]() Gold standard for varicose vein investigations is via duplex ultrasound (best done by a trained technician), assessing valve incompetence at the great/short saphenous veins and any perforators. Table 1 - The CEAP classification for the clinical manifestations of varicose veins * I n the UK, cosmetic issues alone does not qualify for treatment of varicose veinsĬ0 -No visible or palpable signs of venous disease C1 - Telangiectasias or reticular veins C2 - Varicose veins (C2r - Recurrent varicose veins) C3 - Edema C4 - Changes in skin and subcutaneous tissue secondary to CVD (C4a - Pigmentation or eczema, C4b - Lipodermatosclerosis or atrophie blanche, C4c - Corona phlebectatica) C5 - Healed C6 - Active venous ulcer (C6r Recurrent active venous ulcer)Įp - Primary Es - Secondary (Esi - Secondary intravenous, Ese - Secondary extravenous) Ec - Congenital En - No cause identified They can also present with clinical features of venous insufficiency, such as ulceration, varicose eczema, or haemosiderin deposition. On examination, varicosities will be present in the course of the great and / or short saphenous veins (Fig. Subsequent complications if left untreated can include skin changes, ulceration, thrombophlebitis, or bleeding (often presenting post-trauma). Worsening varicose veins may then cause aching or itching. Patients will typically present initially with cosmetic issues*, presenting with unsightly visible veins or discolouration of the skin There are four major risk factors for the development of varicose veins: Figure 1 - Varicose veins develop from valvular incompetence, resulting in dilation of the superficial venous system. This is done under ultrasound guidance and also may be performed under local (or general) anaesthetic. ![]() Thermal ablation – which involves heating the vein from inside (via radiofrequency or laser catheters), causing irreversible damage to the vein which closes it off.This is done under ultrasound guidance to ensure the foam does not enter the deep venous system, however this method only requires a local anaesthetic. Foam sclerotherapy – injecting a sclerosing (irritating) agent directly into the varicosed veins, causing an inflammatory response that closes off the vein (Fig.The surgeon must be aware of surrounding arterial and nervous structures, such as the saphenous and sural nerves. ![]()
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