Dilated, tortuous superficial veins of lower limbs due to incompetent valves.
History taking
- • Visible veins, aching, heaviness, night cramps, swelling worse after standing
- • Ulceration, skin changes, prior DVT, family history, pregnancy, occupation
Examination
- • Inspection standing: dilated veins, distribution (GSV/SSV)
- • CEAP classification, oedema, lipodermatosclerosis, ulcers
- • Tap test, cough impulse, Trendelenburg test
Red flags
- • Active ulceration (C6), bleeding from varix
- • Superficial thrombophlebitis extending towards SFJ
- • DVT suspected (calf swelling, tenderness)
Differential diagnosis
- • DVT, lymphoedema, cellulitis, post-thrombotic syndrome
Recommended investigations
- • Venous duplex Doppler — confirm reflux and competence of perforators
Diagnosis
- • Clinical + Doppler
Initial treatment / management
- • Conservative: leg elevation, exercise, graduated compression stockings (class II)
- • Procedures: endovenous laser/RFA, foam sclerotherapy, surgical stripping for symptomatic
- • Treat ulcers with 4-layer compression after excluding arterial disease (ABI)
Prescription examples
- • Compression stocking class II (knee-length) daytime use
- • Tab Diosmin 500 mg PO BD x 3 months (venoactive)
- • Topical wound care for ulcers
Follow-up advice
- • Review 6 weeks after intervention
- • Long-term compression to prevent recurrence
Patient counselling
- • Lifestyle: avoid prolonged standing, weight reduction, leg elevation
- • Compression stockings reduce symptoms and complications
Referral criteria
- • Skin changes, ulcers, recurrent varices, suspected DVT
Clinical pearls
- • Always exclude deep venous insufficiency before stripping superficial system
- • Check ABI before applying high-compression bandaging
References
- • NICE CG168: Varicose Veins in the Legs
- • ESVS Clinical Practice Guidelines on Chronic Venous Disease 2022
Educational outpatient guide — verify against local guidelines before clinical use.
