The patient's presentation and image is consistent with varicose veins. Varicose veins are a result of dysfunctional venous valves.
Valvular incompetence leads to distal venous dilation and abnormal blood flow contributing towards the characteristic enlarged and tortuous appearance. They are more prevalent in women and occur most often in the superficial veins of the legs. Prolonged standing can worsen their appearance. In addition to being aesthetically displeasing, the varicose veins can be quite painful.
Jones and Carek review the management of varicose veins. Conservative treatment options include: avoidance of prolonged standing, external compression garments, leg elevation, exercise and weight loss. More aggressive treatment includes: injection sclerotherapy, external lasers, and surgery.
Hamdan reviews varicose veins and venous insufficiency in JAMA. Symptoms of chronic venous disease range from cosmetic spider veins to large painful varicose veins, lipodermatosclerosis of the skin, and ulceration. However, there is no definitive stepwise progression from spider veins to ulceration.
Figure A is a photograph depicting varicose veins in the legs of the patient.
Illustration A highlights the differences between normal and varicose veins.
None of these are responsible for the development of varicose veins.
Jones RH, Carek PJ. Management of varicose veins. Am Fam Physician. 2008 Dec 1;78(11):1289-94. Review.
PMID:19069022 (Link to Abstract)
Hamdan A. Management of varicose veins and venous insufficiency. JAMA. 2012 Dec 26;308(24):2612-21.
PMID:23268520 (Link to Abstract)
USMLE World Step 1 QBank Question #876. Copyright © USMLEWorld, LLC 2012.