Varicose veins

How do I assess a person with varicose veins?

• Identify why the person is concerned about their varicose veins. For many people, it is because of the cosmetic appearance, or worries that they will get worse or cause complications.
• Ask about symptoms that might be caused by the varicose veins. Itching, discomfort, and swelling of the affected leg are commonly reported, but may be due to other causes. Discomfort after prolonged standing, relief with leg elevation or wearing compression stockings, and discomfort over the varicose veins suggest that the symptoms are due to varicose veins.
• Document the location and the severity of the varicose veins.
• Check for any complications:
• Skin changes — areas of pigmentation, eczema, or lipodermatosclerosis (hardened, tight, red or brown skin, which if circumferentially affecting the ankle area may eventually result in an 'inverted champagne bottle' leg).
• Venous leg ulcers — most commonly seen in the ankle (gaiter) area.
• Thrombophlebitis — a tender, inflamed varicose vein with overlying redness and heat and which feels firm owing to the presence of thrombus within the vein. People with thrombophlebitis usually present acutely.
• If use of compression stockings is being considered, measure the ankle-brachial pressure index using a Doppler machine (some experts suggest that this is unnecessary if foot pulses are easily palpable, the person has no symptoms of arterial disease, and strong compression is not being applied). 

• How should I manage uncomplicated varicose veins?

  • Reassure the person that it is unlikely that the varicose veins will lead to complications.
  • Explain that treatment of varicose veins is only considered if they are severe and causing troublesome symptoms.
  • If the person has leg discomfort or swelling:
  • Consider the use of compression stockings:
  • Class 1 (light) or class 2 (medium) below-knee stockings are suitable for most people, with the choice depending on the severity of the varicose veins and tolerability of the compression chosen.
  • Advise the person to try and avoid sitting or standing for long periods of time, and to elevate the legs when possible.
  • Explain that it is not known whether compression stockings prevent worsening of the varicose veins or prevent new ones from appearing.

  
  

  What should I advise pregnant women?

  
  

  • Explain the reasons why varicose veins can appear or worsen during pregnancy:
  • An increase in blood volume putting increased strain on the venous system.
  • Hormones causing relaxation of the muscular walls of blood vessels.
  • The enlarging uterus putting pressure on the pelvic veins and inferior vena cava.
  • Reassure the woman that after pregnancy varicose veins often improve considerably.
  • Advise the woman not to stand for long periods, and to elevate her legs when resting.
  • Consider compression stockings if the varicose veins seem to be causing leg discomfort or swelling, but explain that it is uncertain how effective these are during pregnancy.
  • Explain that it is not known whether compression stockings prevent worsening of the varicose veins or prevent new ones from appearing.