Skip to Main Content


Essential Features


  • • Dilated, tortuous superficial veins in lower extremities, usually bilateral

    • Pigmentation, ulceration, edema suggest concomitant venous stasis disease

    • Classified as primary or secondary

    • Risk factors for varicose veins (VV) include:

    • –Female gender


      –Family history

      –Prolonged standing

      –History of phlebitis




  • • Due to genetic or developmental defects in vein wall causing valvular incompetence

    • Most cases of isolated superficial venous insufficiency are primary




  • • Destruction or dysfunction of valves caused by trauma, deep venous thrombosis (DVT), AV fistula, proximal venous obstruction (pregnancy, pelvic tumor, etc)

    • Disruption of valves results in chronic venous stasis changes

    • Long-standing venous dysfunction leads to chronic skin changes leading to infection




  • • 10–20% of population affected

    • Highest incidence in women 40- to 50-years-old


Clinical Findings


Symptoms and Signs


  • • Variable presentation

    • Many patients are asymptomatic

    • Localized pain (ache or heaviness with prolonged standing), phlebitis

    • Predominantly located medially (saphenous vein)

    • Small, flat blue-green reticular and spider veins indicates venous dysfunction

    • Secondary VV can cause edema, hyperpigmentation, dermatitis, ulcers


Diagnostic Considerations


Rule Out


  • • Chronic deep venous insufficiency

    • Klippel-Trénaunay syndrome: Unilateral VV, limb hypertrophy, cutaneous birthmark (port wine stain/venous malformation)

    • –Therapy: Graduated support stockings, avoid saphenous vein stripping as deep veins often absent




  • • Brodie-Trendelenburg test

    • –Identifies saphenofemoral dysfunction: Elevate leg until varicosities collapse, place tourniquet around mid thigh to occlude reflux from saphenofemoral incompetence

      –If veins fill, implies perforator incompetence

      –If veins remain collapsed, implies saphenofemoral dysfunction

    • Duplex US is test of choice


Treatment and Management


  • • First manage venous insufficiency: Elastic stockings, leg elevation, exercise

    • Avoid prolonged sitting/standing




  • • Operative therapy:

    • 1. Remove entire saphenous vein (for incompetent saphenofemoral junction, varicosities along entire length)

      2. Selective VV removal with stab-avulsion technique

      3. Combined technique

    • Inject small volume of sclerosing solution (0.2% sodium tetradecyl sulfate) into varix, telangiectasia, spider vein; maintain direct pressure for 1 wk with stockings


  • • Persistent or disabling pain

    • Recurrent superficial thrombophlebitis

    • Erosion of overlying skin with bleeding




  • • Hematoma formation

    • Infection

    • Saphenous nerve irritation




  • • 10% recurrence after treatment





Belcaro G et al. Endovascular sclerotherapy, surgery, and surgery plus sclerotherapy in superficial venous incompetence: a randomized, 10 year follow-up trial - final results. Angiology. 2000;51:529.  [PubMed: 10917577]
Gohel MS et al: Randomized clinical trial of compression plus surgery versus compression alone in chronic venous ulceration (ESCHAR ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.