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Varicose Veins

Topic updated on 08/25/17 7:14pm

Overview
 

 
Snapshot
  • A 46-year-old woman presents for the evaluation of “visible” veins in both her lower extremities. She describes this as unappealing, but denies any associated discomfort. She has worked as a cashier for the past 10 years, where she spends the majority of her time standing. On exam, there are palpable, dilated tortuous subcutaneous veins measuring approximately 3.5 mm in diameter while in the upright position.
Introduction
  • Varicose veins
    • palpable, distended, tortuous, subcutaneous veins
    • involved vessels
      • saphenous vein
        • also involves saphenous tributaries
        • may involve non-saphenous superficial veins of the leg
  • Etiology
    • primary (e.g., primary venous disease)
    • secondary (e.g., previous deep vein thrombosis)
    • congenital (e.g., Klippel-Trenaunay syndrome)
  • Pathogenesis
    • may be due to valve incompetence, leading to venous hypertension
      • may result in inflammation and valve remodeling/loss if there is prolonged venous hypertension
  • Epidemiology
    • risk factors
      • advanced age, family history, prolonged standing, and multiparity
    • more common in women than in men
Presentation
  • Symptoms
    • may be asymptomatic or may describe calf heaviness/swelling
  • Physical exam
    • palpable, distended, tortuous, subcutaneous veins
Evaluation
  • Clinical diagnosis
  • Duplex ultrasound
Differential Diagnosis
  • Reticular veins
  • Telangiectasias
Treatment
  • Compression therapy
    • can accompany leg elevation and exercise
  • Vein ablation therapy
Prognosis, Prevention, and Complications
  • Prognosis
    • in untreated patients
      • may be asymptomatic
      • may result in skin changes, venous ulcers, and superficial thrombophlebitis
  • Complications
    • skin changes/venous ulcers
    • may develop complications after certain procedures


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Qbank (1 Questions)

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(M1.CV.64) A 46-year-old female waitress presents to your office complaining of painful, tortuous veins and a feeling of "fullness" in her legs. A photograph of her legs is seen in Figure A. Which of the following is most likely abnormal in this patient?
Topic Review Topic
FIGURES: A          

1. Hydrostatic blood pressure
2. Aortic valve
3. Endothelial tight junctions
4. Venous valves
5. Collagen synthesis

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