Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Varicose veins
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Incidence
More than 50% of men and two-thirds of women have physically identifiable disease. The appearance of varicose veins in childhood is rare although adolescents have incompetent valves. European data indicate that up to 1.5% of adults will suffer a venous stasis ulcer at some point in their lives. Annual healthcare cost in the UK for venous ulceration is estimated at £290 million.
Definition
Varicose veins are abnormal tortuous, dilated, elongated superficial veins. These are most commonly found in the long (LSV) and short saphenous vein (SSV) distribution. Spider veins are dilated smaller cutaneous venules (Figure 105).
Classification: CEAP (clinical, etiological, anatomical, pathological)
Clinical: 0 – no signs of venous disease, 1 – reticular veins, 2 – varicose veins, 3 – oedema, 4 – skin changes (lipodermatosclerosis), 5 – skin changes with healed ulceration, 6 – active ulceration
Aetiological: congenital, primary (no cause), secondary (deep vein thrombosis, traumatic, etc.)
Anatomical: superficial, perforator or deep; location (long or short saphenous)
Pathological: reflux, obstruction, both.
Aetiology
The risk factors for varicose vein include prolonged standing, hereditary, female sex, parity and history of phlebitis. Venous ulcers on the other hand have different risk factors and include old age, obesity, hypertension, trauma, history of venous thrombosis, and low socioeconomic status.
Symptoms
Symptoms range from cosmetic to intractable pain. A burning sensation over the varicose veins is caused by local pressure on cutaneous sensory nerves. In early stages, it causes mild swelling, heaviness and easy fatigability. Dull pain and aching usually starts in the afternoon after long standing and is relieved with leg elevation. Itching is a manifestation of local cutaneous stasis and precedes the onset of dermatitis.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 477 - 481Publisher: Cambridge University PressPrint publication year: 2009