Diagnosis and management of varicose veins in the legs

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Diagnosis and management of varicose veins in the legs: summary of NICE guidance
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4279 (Published 24 July 2013)

 

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Surely this is one of these situations where a stitch in time saves nine. Varicose eczema or varicose ulcers are never the first manifestation.

The earlier management is started the better. Varicose veins should be treated as soon as they show. Varicose veins never get better, they are never really stable and they only get worse.

As a general rule getting in there and sclerosing the vein as soon as it shows means that you don't have to worry about future varicose eczema or ulceration.

When a GP sees a patient, for whatever reason, who has early varicose veins, do they suggest treatment?

Why are varicose veins and their sequelae left so long before they are treated?

Bill

 

Compression Therapy Versus Surgery in the Treatment of Patients with Varicose Veins: A RCT
H. Sella et al
European Journal of Vascular and Endovascular Surgery; Available online 24 March 2014

 

The influence of the training of the muscular component of the musculo-venous pump in the lower extremities on the clinical course of varicose vein disease
Kravtsov PF et al
Vopr Kurortol Fizioter Lech Fiz Kult. 2016;93(6):33-36.

 

Evidence for varicose vein treatment: an overview of systematic reviews
Ricardo de Ávila Oliveira et al
Sao Paulo Med. J., ahead of print Epub July 16, 2018

 

Treatment of varicose veins of lower
extremity: a literature review
Xueke Guo et al
Int J Clin Exp Med 2019;12(3):2142-2150 (full text)

 

Anatomy of foot perforator veins in surgery of varicose veins
Kalinin RE, Suchkov IA, Shanaev IN
Khirurgiia, 01 Jan 2021, (1):69-76Language:rus

 

NEWS RELEASE 8-JUN-2021
Internal compression stocking helps against varicose veins

Applying a thin sheath around the defective vein eliminated the varicose vein problem in over 95 per cent of cases. The research team published their findings in the Journal of International Medical Research on 6 April 2021.

When the blood pools in the leg

Varicose veins are more than just a cosmetic problem: the unsightly bulges might result in serious health problems such as leg ulcers, thromboses or even pulmonary embolisms. The cause of varicose vein disease is usually a weakness in the connective tissue, which causes the vein wall to give way and thus the vein diameter to grow. This process is accelerated by pregnancy or frequent standing and sitting.

The increase in vein diameter impairs the function of the vein valves. The valve leaflets are pulled apart and a leak develops, which is called valve insufficiency. The blood pools in the leg where it leads to an increase in venous blood pressure. This valve insufficiency most often affects the truncal vein, also called the great saphenous vein or great rose vein, which opens in the groin.

Like a second skin

The therapy concepts to date have been based on a radical approach: destruction by laser or by radio wave therapy, or removal of insufficient truncal veins by stripping surgery. "At the RUB Hospital, we have developed an alternative to the radical methods with the procedure of extraluminal valvuloplasty, which adopts an organ-preserving approach," explains Professor Achim Mumme, Director of Vascular Surgery. Venous valves are repaired through a small incision in the groin. A sheath of wafer-thin polyurethane is placed around the dilated vein like a second skin. The sheath acts as a kind of internal compression stocking that returns the vein, which is weak in connective tissue, to its normal diameter.

Use primarily when risk factors for circulatory disorders are present

In a multicentre study, the team tested the effectiveness of the organ-preserving treatment method. "With a success rate of 95.24 per cent, vein repair with the novel polyurethane sheath proved to be an effective therapeutic alternative to radical treatment methods," outlines study supervisor Dominic Mühlberger. "The great advantage of extraluminal valvuloplasty is that the truncal vein is preserved - unlike in radical therapy methods."

This is especially important if circulatory problems occur at a later stage in life. In this case, the presence of suitable bypass material can be decisive for the treatment options. The truncal veins are needed as vascular graft in cardiovascular surgery. Whereas the lack of suitable autologous replacement material worsens the prognosis.

"Vein-preserving therapy for varicose veins should be used above all when risk factors for the development of circulatory disorders are present, such as smoking, high blood pressure, diabetes or lipometabolic disorders," concludes Mühlberger.

 

Exploring causal correlations between inflammatory cytokines and varicose veins: A Mendelian randomization analysis
Shen Min, Mengzhen Xing, Hehe Jiang, Linlin Zhang, Chen Chen, Yuning Ma, Yuxia Ma
14 February 2024

 

Hypothesis: Pump shoes for the prevention and treatment of varicose veins
Alireza Jahanbani
Phlebology. 2024 Jun 6

 

Varicose Veins of the Lower Extremities: A Primer Part I

 

Varicose Veins of the Lower Extremities: A Primer Part II

 

News Release 15-Apr-2025
Symptoms of ice cold feet + heaviness in legs strongly linked to varicose veins

Hypersensitivity to the cold, especially ice cold feet, as well as a feeling of heaviness in the legs, are linked to the presence of varicose veins, finds a large study published in the open access journal Open Heart.

Cold hypersensitivity is often underestimated as a subjective symptom, say the researchers.

Varicose veins are usually caused by impaired functioning of the deep or superficial veins, and the perforator veins (short veins that link the superficial and deep venous systems in the legs).

The prevalence of varicose veins ranges from 2% to 30% in adults, with women at higher risk. And symptoms include sensations of heaviness, aching, throbbing, and itching; restlessness in the legs; fluid retention and swelling; muscle cramps; and leg ulcers in severe cases.

Previously published research indicates that heightened sensitivity to cold may be associated with varicose veins, note the researchers. To explore this further, they mined data covering the period January 2008 to December 2020 inclusive from the Taiwan Biobank, the largest genetic and population-based database in Taiwan.

In all, 8782 participants aged between 30 and 70 with moderate and severe varicose veins were included in the analysis. They were quizzed about their hypersensitivity to cold in their feet and the extent to which they felt heaviness in their legs.

And information on potentially influential factors was collected on sex, diet (vegetarian), age, cigarette smoking, alcohol intake, regular exercise, weight (BMI), education level, job type (predominantly standing or sedentary), and presence of diabetes and high blood pressure.

In all, 676 participants said they had moderate to severe varicose veins.

Of the total number of participants, 5888 said they weren’t hypersensitive to the cold, just under 6% (340) of whom had varicose veins.

Of the remainder, 1535 participants said they were moderately hypersensitive to the cold, just over 9% (144) of whom had varicose veins; and 1359 said they were extremely hypersensitive to the cold, just over 14% (192) of whom had varicose veins.

Statistical analysis showed that moderate to severe cold hypersensitivity was associated with a 49%-89% heightened likelihood of varicose veins compared with no hypersensitivity.

Similarly, 4 times as many people with varicose veins had heavy legs as those without the condition.

Job type was also an influential factor: jobs involving prolonged standing were associated with a 45% higher likelihood of varicose veins.

The association between cold hypersensitivity and heavy legs was significant.

In the absence of cold hypersensitivity, the likelihood of varicose veins and heaviness in the legs was 7 times greater than in those who didn’t report leg heaviness.

Among those who did report this symptom, the likelihood of varicose veins was 90% higher for those with moderate cold hypersensitivity, and more than 3 times as high among those reporting extreme hypersensitivity to the cold.

And compared with those reporting neither cold hypersensitivity nor heaviness in the legs, moderate and severe cold hypersensitivities were associated with an 80% and more than doubling in the likelihood of varicose veins, respectively.

This is an observational study, and as such can’t establish causal factors. It also relied on subjectively assessed self report rather than clinical assessment, added to which no information was available on any forms of treatment for varicose veins.

But the researchers point out: “Healthcare providers frequently underestimate the gravity and implications of varicose veins, leading to their neglect, and there is usually a gap in understanding the comprehensive spectrum of linked symptoms.”

They add: “In clinical practice, the sensation of coldness is usually relegated to a secondary position among the many varicose vein symptoms. This relegation is attributed to its subjectivity and the consequent ease with which it can be overlooked.

“However, our study showed the presence of a moderate-to-severe degree of hypersensitivity to cold in the lower extremities, which has hitherto been underestimated as a subjective symptom associated with varicose veins.

“Of note is the significance of the concurrent symptoms of heaviness and cold feet. When these symptoms coexist, the likelihood of confirming the presence of varicose veins is notably amplified compared with individuals without such symptoms.”

 

A Multicenter, Randomized, Controlled, Clinical Trial Evaluating a Lyopreserved Amniotic Membrane in the Treatment of Venous Leg Ulcers
Yadwinder Dhillon et al
Health Sci Rep. 2025 May 4;8(5):e70819.