Varicose Veins-audio

Varicose veins are dilated, tortuous veins, engorged with blood and resulting from poor venous valve function. They can be primary, originating in the superficial veins, or secondary, occurring in the deep veins.
Causes
Primary varicose veins
Congenital weakness of valves or vein wall
Prolonged venous stasis or increased intra-abdominal pressure, as in pregnancy, obesity, constipation, or wearing tight clothes
Standing for an extended period of time
Family history
Secondary varicose veins
Deep vein thrombosis
Venous malformation
Arteriovenous fistulas
Venous trauma
Occlusion
Pathophysiology
Veins are thin-walled, distensible vessels with valves that keep blood flowing in one direction. Any condition that weakens, destroys, or distends these valves allows the backflow of blood to the previous valve. If a valve can’t hold the pooling blood, it can become incompetent, allowing even more blood to flow backward. The increasing volume of blood in the vein raises pressure and distends the vein. As the veins are stretched, their walls weaken and lose their elasticity, and they become lumpy and tortuous. Rising hydrostatic pressure forces plasma into the surrounding tissues, resulting in edema.
People who stand for prolonged periods may also develop venous pooling because there’s no muscular contraction in the legs, forcing blood back up to the heart. If the valves in the veins are too weak to hold the pooling blood, they begin to leak, allowing blood to flow backward.
Signs and symptoms
Dilated, tortuous, purplish, ropelike veins, particularly in the calves
Edema of the calves and ankles
Leg heaviness that worsens in the evening and in warm weather
Dull aching in the legs after prolonged standing or walking
Aching during menses
Diagnostic test results
Photoplethysmography characterizes venous blood flow by noting changes in the skin’s circulation.
Doppler ultrasonography detects the presence or absence of venous backflow in deep or superficial veins.
Venous outflow and reflux plethysmography detects deep vein occlusion; this test is invasive and not routinely used.
Ascending and descending venography demonstrates venous occlusion and patterns of collateral flow.
Treatment
Treatment of underlying cause (if possible), such as abdominal tumor or obesity
Antiembolism stockings or elastic bandages
Regular exercise
Injection of a sclerosing agent into small to medium-sized varicosities
Surgical stripping and ligation of severe varicose veins
Phlebectomy (removing the varicose vein through small incisions in the skin)

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