Varicose veins

Abstract

Varicose veins are dilated, tortuous bulging veins in the legs caused by superficial venous reflux, most commonly in the great and short saphenous veins. This is part of a spectrum of chronic venous disease which is a significant cause of patient distress and health service burden. The assessment of patients with venous disease involves a detailed history and careful examination of the legs for the distribution of veins and skin changes. The gold-standard investigation is duplex ultrasound scanning to identify reflux and obstruction in superficial and deep veins. Superficial venous reflux is the most common abnormality seen and there have been significant advances in recent years away from traditional surgical stripping operations, to minimally invasive endovenous ablation modalities. Modern varicose vein procedures are performed under local anaesthesia with small incisions, low risks of complications and a rapid return to normal activities. Careful patient consent is imperative as is a shared decision-making process with the patient to identify their priorities and adopt the optimal treatment strategy to achieve the best outcomes.