subject: Pathogenesis Of Varicosity [print this page] Chronic venous disease of the lower limbs is one of the most common medical conditions seen in clinical practice. There is some disagreement over the actual prevalence of chronic venous insufficiency due to the lack of a standardized definition. There have been several large epidemiological studies with varied criteria for venous disease.
Amazingly, approximately 50% of middle aged adults have varicose veins. Definitions range from any prominent superficial vein in the lower extremity to a vein which has permanently lost its valvular efficiency and, as a result of continuous dilation under pressure, in the course of time becomes elongated, tortuous, pouched and thickened.
Specialists assessed all of the studies with regard to age range and distribution of study population, criteria used to diagnose varicose veins, geographical site of the study population and methods used to assess venous disease. They reported half of the adult population manifesting minor venous disease, and less than half (women 20-25%; men 10-15%) having visible varicose veins.
The pathogenesis of varicose veins is thought to include increased venous and capillary pressures, increased capillary permeability, chronic edema, repeated inflammation, and stasis. Some of the risk factors associated with developing varicose veins are obesity, high systolic blood pressure, cigarette smoking, low levels of physical activity, pregnancy, abdominal or pelvic masses, ascites, and occupations that require prolonged standing.
Patients will often self-diagnose varicose veins and present to the physician with elongated, dilated, tortuous superficial veins (usually in the legs) whose valves have become incompetent. Patients may experience aching, fatigue, or heat that is relieved by elevation or wearing compressive hosiery.
Symptoms are not always related to the degree or size of the varicose veins. Patients who present with asymptomatic varicosities often seek treatment for cosmetic reasons. Primary varicose veins are not associated with deep venous disease, and treatment is indicated to relieve symptoms and improve appearance.
Treatment is particularly valuable to clear excessive discharge or accumulation of fluid in venous tissue. However, treatment is rarely required to prevent further complications. Varicosities that occur secondary to obstruction and valvular incompetence of the deep venous system are much more serious because of the associated risk of pulmonary thromboembolism.
Physicians evaluating a patient for presumed varicose veins must rule out other possible causes for the presenting symptoms: lumbar nerve root irritation can cause an aching sensation in the leg; peripheral neuritis causes a burning sensation in the leg; and arterial insufficiency may present with intermittent claudication.
A deep vein thromboembolism can present with calf pain, and patients on estrogen have an increased risk. Osteoarthritis of the hip and knee are also considerations in the differential diagnosis of varicose veins. The pain associated with varicose veins is uniquely relieved with leg elevation.
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