Varicose veins

Last Updated: 2021-10-15

Author(s): Anzengruber F., Navarini A.

ICD11: -

Varicose veins, spider veins, varicosis, varices, reticular varices, varicose veins. 

Degenerative disease of the vein walls leads to pathologically dilated, epifascial veins, usually in the course of the saphenous veins magna and parva.

  • Women > Men
  • There are different data regarding the incidence. It can be assumed that about 1/3 of the population suffer from relevant varicose veins. There is a significant increase in old age. The first symptoms can appear as early as 20 years of age.

  • Primary varicosis: Degeneration of the vascular wall.

  • Secondary varicosis: Vascular wall caused by another disease. 
    • Valvular agenesis 
    • Arteriovenous fistula

    • Klippel-Trénaunay syndrome 

  • Spider vein varices (telangiectasias): Dilatations of the subpapillary intradermal vein plexus caused by localized venous hypertension or primary vascular wall weakness.

  • Reticular varices: Net-like areas with broom tears on the lateral thigh or lower leg and in the hollow of the knee.

  • Stem varices: Varicose alteration of V. saphena magna (80-85%) or V. saphena parva (15-20%).

  • Lateral branch varices: From the branches of Vv. saphenae.

  • Perforating veins:  Insufficiency of the Boyd or Dodd perforating vein can lead to varicosis.

  • Pregnancy varicosis: Mostly reversible varicoses occurring during pregnancy (in about 1/3 of first pregnant women, in 2/3 of multiparous women.

Severity according to Widmer/Partsch 

Varicosities 

Subjective complaints (pruritus, heaviness, dysesthesia, swelling)

Hypostatic eczema, hyperpigmentation, atrophy 

Ulcers 
Degree 1 + - - -
Degree 2 + + - -
Degree 3 + + + -
Degree 4 + + + +

 

  • Due to remodeling processes, contractile abilities, vasodilatation and finally valve insufficiency decrease.

Predisposing factors 

  • Genetics 
  • Increasing age 
  • Standing
  • Gestation
  • Adiposity 
  • Family disposition (genetic factors)

  • Hormones

  • Depending on the clinic, telangiectasias to dilated vessels may be visible.
  • Classification by Hach 
    • V. saphena magna
      • Grade I: Insufficiency of the krosse (reflux up to approx. hand width below the groin)

      • Grade II: Insufficiency of the krosse (reflux to hand width above the knee)

      • Grade III: Insufficiency of the krosse (reflux to below the knee)

      • Grade IV: Insufficiency of the krosse (reflux to the ankle)

    • V. saphena parva 
      • Grade I: Insufficiency of the krosse at the sluice flap/junction.

      • Grade II: Insufficiency of krosse up to the middle of the US.

      • Grade III: Insufficiency of krosse to the lat. ankle.

  • Medical history 
  • Phlebological examination 
    • Doppler sonography 
    • Duplex sonography 
    • Light reflection rheography 

  • Chronic venous insufficiency 
  • Variceal hemorrhage 
  • Thromboses 

·         Sclerosing 

·         Surgery (crossectomy, stripping)

·         Compression treatment 

 

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