varicose vein

Definition

Varicose veins are dilated, tortuous, elongated superficial veins that are usually seen in the legs.

Description

Varicose veins, also called varicosities, are seen most often in the legs, although they can be found in other parts of the body. Most often, they appear as lumpy, winding vessels just below the surface of the skin. There are three types of veins, superficial veins that are just beneath the surface of the skin, deep veins that are large blood vessels found deep inside muscles, and perforator veins that connect the superficial veins to the deep veins. The superficial veins are the blood vessels most often affected by varicose veins and are the veins seen by eye when the varicose condition has developed.

The inside wall of veins have valves that open and close in response to the blood flow. When the left ventricle of the heart pushes blood out into the aorta, it produces the high pressure pulse of the heartbeat and pushes blood throughout the body. Between heartbeats, there is a period of low blood pressure. During the low pressure period, blood in the veins is affected by gravity and wants to flow downward. The valves in the veins prevent this from happening. Varicose veins start when one or more valves fail to close. The blood pressure in that section of vein increases, causing additional valves to fail. This allows blood to pool and stretch the veins, further weakening the walls of the veins. The walls of the affected veins lose their elasticity in response to increased blood pressure. As the vessels weaken, more and more valves are unable to close properly. The veins become larger and wider over time and begin to appear as lumpy, winding chains underneath the skin. Varicose veins can develop in the deep veins also. Varicose veins in the superficial veins are called primary varicosities, while varicose veins in the deep veins are called secondary varicosities.

— John T. Lohr, PhD

(anatomy) An enlarged tortuous blood vessel that occurs chiefly in the superficial veins and their tributaries in the lower extremities. Also known as varicosity.

For more information on varicose vein, visit Britannica.com.

A varix or varicosity is an irregularity or lumpiness. In the body, this means irregularities caused by dilated and distorted veins.

Veins in the legs have valves which normally prevent any backflow of the blood on its way towards the heart. The pressure of the blood tending to distend these veins is greater than in veins elsewhere simply because, for most of most people's waking hours, they are lower than the rest of the body, and vertical. This can put a considerable strain on the valves, each of which supports the column of blood immediately above it, between it and the next valve further up. In ideal normal circumstances the blood is kept moving upwards effectively because of persistent squeezing of veins by actively contracting muscles as we walk about, as well as by other mechanisms which tend continually to draw the blood towards the chest. The superficial veins just under the skin benefit less directly than the deep ones from leg movements — but because they connect to the deep veins, squeezing by the muscles helps to siphon blood from those near the surface, as well as ‘milking’ it up the deep ones.

Thus gravity does not normally cause an accumulation of weighty blood in our lowest parts, as it would in, say, a liquid-filled bicycle inner tube suspended vertically. But there are less than ideal circumstances which cause relative stagnation, particularly in the superficial unsupported veins; blood then leans more heavily on the valves, and in some cases these become damaged and develop leaks. This can occur if there is an obstruction to blood flow up from the legs (such as a heavily pregnant uterus pressing on the veins in the pelvic cavity) and the problem is exacerbated by sitting or standing still. As for many bodily dysfunctions, there is no doubt a combination of innate propensity (weak veins and valves) and risk factors (flow obstruction and immobility). The leakage of valves in turn leads to the irregular bulges on the veins which are known as varicosities, along with enlargement and distortion. The sluggishness imposed on the circulation to the skin and underlying tissues by back pressure from these veins predisposes to discomfort, ulceration, and oedema.

Applying pressure by support stockings to keep the varicose veins from filling is the first line of treatment. But the veins which are affected are fortunately usually dispensible: if they are removed, blood can flow through alternative deeper channels. Effective surgical treatment involves making cuts only at the top and the bottom of the offending vein, which is then removed by using a ‘stripper’. From the top end (say at the knee) a thin flexible rod is passed down the vein to the far end (say at the ankle). The vein is tied around the rod, which has a knob on its end. Pulling from the top then causes the knob to draw the whole length of the vein up before it, ‘crumpling’ it as it comes. Thus the vein is pulled by the stripper from under the skin and out through the upper incision.

A similar problem can occur at other sites. In the lower end of the oesophagus, ‘varices’ may result from back pressure associated with liver disease. In the scrotum a ‘varicocoele’ is a swelling of the veins around the testis. Haemorrhoids represent a comparable condition of the anal veins.

— Sheila Jennett

See also blood circulation; blood vessels.

Veins, commonly in the legs, which have become distended and twisted as a result of weakening of their walls and valves. Because they protrude, they are ruptured relatively easily. Ruptured veins bleed heavily, but the application of firm pressure usually brings the bleeding under control quickly. Obese individuals, pregnant women, those who regularly stand for prolonged periods, and the physically inactive are particularly susceptible. As long as varicose veins are not associated with other symptoms that may indicate a more sinister condition, a controlled programme of physical exercise may improve circulation and benefit sufferers.

Definition

Varicose veins are dilated, tortuous, elongated superficial veins that appear most often in the legs.

Description

Varicose veins, also called varicosities, are seen most often in the legs, although they can be found in other parts of the body. Most often, they appear as lumpy, winding vessels just below the surface of the skin. There are three types of veins: superficial veins that are just beneath the surface of the skin; deep veins that are large blood vessels found deep inside the muscles; and perforator veins that connect the superficial veins to the deep veins. The superficial veins are the blood vessels most often affected by this condition and are the veins that are visible when the varicose condition has developed.

The inside walls of veins have valves that open and close in response to the blood flow. When the left ventricle of the heart pushes blood out into the aorta, it produces the high pressure pulse of the heartbeat and pushes blood throughout the body. Between heartbeats, there is a period of low blood pressure. During this period blood in the veins is affected by gravity and wants to flow downward. The valves in the veins prevent this from happening. Varicose veins start when one or more valves fail to close. The blood pressure in that section of vein increases, causing additional valves to fail. This allows blood to pool and stretch the veins, further weakening the walls of the veins. The walls of the affected veins lose their elasticity in response to increased blood pressure. As the vessels weaken, more and more valves are unable to close properly. The veins become larger and wider over time and begin to appear as lumpy, winding chains underneath the skin. Varicosities can also develop in the deep veins. Varicose veins in the superficial veins are called primary varicosities, while varicose veins in the deep veins are called secondary varicosities.

Causes & Symptoms

Varicose veins have a number of different causes; lifestyle and hormonal factors play a role. Some families seem to have a higher incidence of varicose veins, indicating that there may be a genetic component to this disease. Varicose veins are progressive; as one section of a vein weakens, it causes increased pressure on adjacent sections of the vein. These sections often develop varicosities. Varicose veins can appear following pregnancy, thrombophlebitis, congenital blood vessel weakness, or obesity, but they are not limited to these conditions. Edema of the surrounding tissue, ankles, and calves is not usually a complication of primary (superficial) varicose veins. When edema develops, it usually indicates that the deep veins may have varicosities or clots.

Varicose veins are a common problem. More than 80 million Americans experience the symptoms and complications of varicose veins, including 10%–15% of men and 20%–25% of women. The symptoms can include aching, pain, itchiness, or burning sensations, especially when standing. In some cases, with chronically bad veins, there may be a brownish discoloration of the skin or ulcers (open sores) near the ankles. A condition that is frequently associated with varicose veins is spider-burst veins. Spider-burst veins are very small veins that are enlarged. They may be caused by back-pressure from varicose veins, but can be caused by other factors. They are frequently associated with pregnancy and there may be hormonal factors associated with their development. They are primarily of cosmetic concern and do not present any medical concerns.

Diagnosis

Varicose veins can usually be seen. In cases where varicose veins are suspected, a physician may frequently detect them by palpation (pressing with the fingers). The physician will examine the veins while the patient is first in a standing position and a second time while the patient is lying down. X rays or ultrasound tests can detect varicose veins in the deep and perforator veins and rule out blood clots in the deep veins. A handheld Doppler instrument is now the preferred diagnostic tool for evaluating the leg veins.

Treatment

There is no cure for varicose veins. Treatment falls into two classes: relief of symptoms and removal of the affected veins. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. This pressure keeps the veins from stretching and limits pain. Other measures include sitting down, using a footstool to support the feet when sitting, avoid standing for long periods of time, and raising the legs whenever possible. These measures work by reducing the blood pressure in leg veins. Prolonged standing allows the blood to collect under high pressure in the varicose veins. Exercise such as walking, biking, and swimming, is beneficial. When the legs are active, the leg muscles help pump the blood in the veins. This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms but does not stop the disease.

Herbal therapy can be helpful in the treatment of varicose veins. Essential oils of cypress and geranium or extracts from horse chestnut seeds (Aesculus hippocastanum) are massaged into the legs, stroking upwards toward the heart. Application to broken skin and massage directly on the varicose veins should be avoided. Horse chestnut may also be taken orally and biothavenoids are used to increase vascular stability. In late 2001 a new product derived from aescinate, a chemical found in horse chestnut, was approved by the Food and Drug Administration (FDA) for topical use in the treatment of varicose and spider veins. The new product, sold under the name of Essaven gel, reduces edema. It can be applied underneath support hosiery if desired.

Drinking fresh fruit juices, particularly those of dark colored berries (cherries, blackberries, and blueberries) can help tone and strengthen the vein walls. The enzyme bromelain, found in pineapple juice, can aid in the prevention of blood clots associated with the pooling of blood in the legs.

Deep breathing exercises performed while lying down with the legs elevated can assist gravity in circulating blood from the legs. The flow of fresh blood into the legs can help relieve any pain.

Allopathic Treatment

Surgery can be used to remove varicose veins from the body. It is recommended for varicose veins that are causing pain or are very unsightly, and when hemorrhaging or recurrent thrombosis appear. Surgery involves making an incision through the skin at both ends of the section of vein being removed. A flexible wire is inserted through one end and extended to the other. The wire is then withdrawn, pulling the vein out with it. This is called "stripping" and is the most common method to remove superficial varicose veins. As long as the deeper veins are still functioning properly, a person can live without some of the superficial veins. Because of this, stripped varicose veins are not replaced.

Injection therapy is an alternate therapy used to seal varicose veins. This prevents blood from entering the sealed sections of the vein. The veins remain in the body, but no longer carry blood. This procedure can be performed on an out-patient basis and does not require anesthesia. It is frequently used if people develop more varicose veins after surgery to remove the larger varicose veins and to seal spider-burst veins for people concerned about cosmetic appearance. Injection therapy is also called sclerotherapy. At one time, a method of injection therapy was used that did not have a good success rate. Veins did not seal properly and blood clots formed. Modern injection therapy is improved and has a much higher success rate.

Two new allopathic treatments have been developed since 1999 that are much less invasive than stripping the veins. One is called radio frequency closure, or the closure technique. In radio frequency closure, the surgeon inserts a catheter into the varicose vein through a small puncture. The catheter is used to deliver radio frequency energy to the wall of the vein, which causes the vein to contract and seal itself shut. The nearby veins then take over the flow of venous blood from the legs.

The second new treatment is called the endovascular laser procedure. The doctor uses a diode laser wire or fiber that is inserted directly into the vein. Energy transmitted from a laser heats the varicose vein and seals it shut. The patient can go back to work the next day, although a support stocking must be worn for two weeks after the laser procedure.

Expected Results

Untreated varicose veins become increasingly large and more obvious with time. Surgical stripping of varicose veins is successful for most patients. Most do not develop new, large varicose veins following surgery. Surgery does not decrease a person's tendency to develop varicose veins. Varicose veins may develop in other locations after stripping.

Prevention

While genetic factors play a significant role in the development of varicose veins, swimming and other exercises to increase circulation in the legs help to prevent varicose veins. Preventive measures are especially important during pregnancy, when the additional weight of the fetus and placenta can exert pressure on the mother's legs and feet.

Resources

Books

Alexander, R.W., R. C. Schlant, and V. Fuster, eds. The Heart, 9th ed. New York: McGraw-Hill, 1998.

Berkow, Robert, ed. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 1997.

Larsen, D.E., ed. Mayo Clinic Family Health Book. New York: William Morrow and Company, Inc., 1996.

Periodicals

Altizer, James W. "Varicose Veins: A Primary Care Update." Patient Care 35 (October 30, 2001): 33.

Belcaro, G., A. N. Nicolaides, G. Geroulakis, et al. "Essaven Gel: Review of Experimental and Clinical Data." Angiology 52 (December 2001): S1-S4.

"New Noninvasive Procedures Treat Leg Veins Problems." Medical Devices & Surgical Technology Week (December 9, 2001): 16.

[Article by: Kathleen D. Wright; Rebecca J. Frey, PhD]

Veins, commonly in the legs, which have become abnormally distended and twisted as a result of incompetence of internal valves. Varicose veins may bleed heavily if ruptured, in which case the application of firm pressure easily controls the bleeding. As long as varicose veins are not associated with other symptoms, a controlled programme of physical exercise may improve circulation and benefit sufferers.

For other uses, see varices.

Varicose veins
Classification and external resources
A person affected by varicose veins.
ICD-10	I83., I84., I85., I86.
ICD-9	454-456, 671
OMIM	192200
DiseasesDB	13734
MedlinePlus	001109
eMedicine	med/2788
MeSH	D014648

Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg,^[1]although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves don't work. This allows blood to flow backwards and they enlarge even more. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. They often itch, and scratching them can cause ulcers. Serious complications are rare. Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise. The traditional surgical treatment has been vein stripping to remove the affected veins. Newer, less invasive treatments, such as ultrasound-guided foam sclerotherapy, radiofrequency ablation and endovenous laser treatment, are slowly replacing traditional surgical treatments. Because most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm.^[2][3] Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins), which also involve valvular insufficiency,^[4] by the size and location of the veins. Many patients who suffer with varicose veins seek out the assistance of physicians who specialize in vein care. These physicians are called phlebologists.

Contents 1 Symptoms 2 Stages 3 Complications 4 Causes 5 Conservative treatment 6 Interventional treatment 6.1 Surgical treatment 6.1.1 Stripping 6.1.2 CHIVA 6.1.3 Other 6.2 Non-surgical treatment 6.2.1 Sclerotherapy 6.2.2 Endovenous thermal ablation 7 References 8 External links

Symptoms

• Aching, heavy legs (often worse at night and after exercise).
• Appearance of spider veins (telangiectasia) in the affected leg.
• Ankle swelling.
• A brownish-blue shiny skin discoloration near the affected veins.
• Redness, dryness, and itchiness of areas of skin - termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
• Cramps may develop especially when making a sudden move as standing up.
• Minor injuries to the area may bleed more than normal and/or take a long time to heal.
• In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.
• Restless legs syndrome appears to be a common overlapping clinical syndrome in patients with varicose veins and other chronic venous insufficiency.
• Whitened, irregular scar-like patches can appear at the ankles. This is known as atrophie blanche.

Stages

• C0 no visible or palpable signs of venous disease
• C1 telangectasia or reticular veins
• C2 varicose veins
• C3 edema
• C4a skin changes due to venous disorders: pigmentation, eczema
• C4b skin changes due to venous disorders: lipodermatosclerosis, atrophie blanche
• C5 as C4 but with healed ulcers
• C6 skin changes with active ulcers

Complications

Most varicose veins are relatively benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.

• Pain, heaviness, inability to walk or stand for long hours thus hindering work
• Skin conditions / Dermatitis which could predispose skin loss
• Skin ulcers especially near the ankle, usually referred to as venous ulcers.
• Development of carcinoma or sarcoma in longstanding venous ulcers. There have been over 100 reported cases of malignant transformation and the rate is reported as 0.4% to 1%.^[5]
• Severe bleeding from minor trauma, of particular concern in the elderly.
• Blood clotting within affected veins. Termed superficial thrombophlebitis. These are frequently isolated to the superficial veins, but can extend into deep veins becoming a more serious problem.
• Acute fat necrosis can occur, especially at the ankle of overweight patients with varicose veins. Females are more frequently affected than males.

Causes

The illustration shows how a varicose vein forms in a leg. Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg.

Varicose veins are more common in women than in men, and are linked with heredity^[6]. Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. Varicose veins are bulging veins that are larger than spider veins, typically 3 mm or more in diameter.

Less commonly, but not exceptionally, varicose veins can be due to other causes, as post phlebitic obstruction and/or incontinence, venous and arteriovenous malformations^[7].

Conservative treatment

The symptoms of varicose veins can be controlled to an extent with the following:

• Elevating the legs often provides temporary symptomatic relief.
• "Advice about regular exercise sounds sensible but is not supported by any evidence."^[8]
• The wearing of graduated compression stockings with a pressure of 30–40 mmHg has been shown to correct the swelling, nutritional exchange, and improve the microcirculation in legs affected by varicose veins.^[9] They also often provide relief from the discomfort associated with this disease. Caution should be exercised in their use in patients with concurrent arterial disease.
• Diosmin.
• anti-inflammatory medication such as ibuprofen or aspirin can be used as part of treatment for superficial thrombophlebitis along with graduated compression hosiery – but there is a risk of intestinal bleeding. In extensive superficial thrombophlebitis, consideration should be given to anti-coagulation, thrombectomy or sclerotherapy of the involved vein.

Interventional treatment

Active medical intervention in varicose veins can be divided into surgical and non-surgical treatments. Some doctors favor traditional open surgery, while others prefer the newer methods. Newer methods for treating varicose veins such as Endovenous Thermal Ablation (endovenous laser treatment or radiofrequency ablation), and foam sclerotherapy are not as well studied, especially in the longer term.^[10][11]

Surgical treatment

Several techniques have been performed for over a century, from the more invasive saphenous stripping, to less invasive procedures like ambulatory phlectomy and CHIVA.

Stripping

Stripping consists of removal of all or part the saphenous vein main trunk. The complications include deep vein thrombosis (5.3%),^[12] pulmonary embolism (0.06%), and wound complications including infection (2.2%). For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5-60%. In addition, since stripping removes the saphenous main trunks, they are no longer available for venous bypass in the future (coronary and/or leg artery vital disease)^[13]

CHIVA

CHIVA is an acronym from the scientific paper "Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire"^[14] published in France in 1988. CHIVA relies on an hemodynamic impairment assessed by data and evidences depicted through ultrasound dynamic venous investigations. According to this new concept, the clinical symptoms of venous insufficiency are not the cause but the consequence of various abnormalities of the venous system. For example, a varicose vein being overloaded, may be dilated not only because of valvular incompetence (the most frequent) but because of a venous block (thombosis) or arterio-venous fistulae and so the treatment has to be tailored according the hemodynamic features. It generally consists in 1 to 4 small incisions under local anaesthesia in order to disconnect the varicose veins from the abnormal flow due to valvular incompetence which dilates them.^[15] The patient is dismissed the same day. This method leads to an improvement of the venous function^{[citation needed]} in order to:

• Cure the symptoms of venous insufficiency as varicose veins, legs swelling, ulcers.^[16][17]
• Prevent varicose recurrence due to progressive enlargement of collateral veins which replace and overtake the destroyed veins: CHIVA vs Stripping: varicose recurrence divided by 2 to 5 at 10 years.^[18]
• Preserve the superficial venous capital for unpredictable but possible need for coronary or leg artery vital by-pass which increases with ageing.

Lurie^[19] in his analysis of Chiva states that "CHIVA definitely falls into a research category and should be continued as such until sufficient evidence of its validity is generated".Unfortunately at this stage, the best available publication of CHIVA outcomes that meets current methological standards^[19] is a study by Carandina et al. ^[18]. The authors estimate that only 30-35% of patients with varicose veins can be treated with CHIVA. This study showed that there were recurrent varices in 18% of cases treated by CHIVA despite there being some bias in the selection of patients favoring CHIVA.^[19]

Other

Other surgical treatments are:

• Ambulatory phlebectomy
• Vein ligation

Non-surgical treatment

Sclerotherapy

A commonly performed non-surgical treatment for varicose and "spider" leg veins is sclerotherapy in which medicine is injected into the veins to make them shrink. It has been used in the treatment of varicose veins for over 150 years.^[20] Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping.^[21][22] Sclerotherapy can also be performed using foamed sclerosants under ultrasound guidance to treat larger varicose veins, including the great and short saphenous veins.^[23][24] A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution.^[25] A Cochrane Collaboration review^[26] concluded sclerotherapy was better than surgery in the short term (1 year) for its treatment success, complication rate and cost, but surgery was better after 5 years, although the research is weak.^[27] A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux.^[28] This Health Technology Assessment monograph includes reviews of the epidemiology, assessment, and treatment of varicose veins, as well as a study on clinical and cost effectiveness of surgery and sclerotherapy. Complications of sclerotherapy are rare but can include blood clots and ulceration. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready.^[29][30] There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected.

Endovenous thermal ablation

The Australian Medical Services Advisory Committee (MSAC) in 2008 has determined that endovenous laser ablation (ELA) for varicose veins "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and vein stripping for the treatment of varicose veins."^[31] It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury and paraesthesia, post-operative infections and haematomas, appears to be greater after ligation and stripping than after EVLT". Complications for ELA include minor skin burns (0.4%)^[32] and temporary paraesthesia (2.1%). The longest study of endovenous laser ablation is 39 months.

Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency ablation (ERA) compared to open surgery^[33][34]. Myers^[35] wrote that open surgery for small saphenous vein reflux is obsolete. Myers said these veins should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%. In comparison, ERA has been shown to control 80% of cases of small saphenous vein reflux at 4 years, said Myers. Complications for ERA include burns, paraesthesia, clinical phlebitis, and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolism (0.17%).One 3-year study compared ERA, with a recurrence rate of 33%, to open surgery, which had a recurrence rate of 23%.

ELA and ERA require specialized training for doctors and expensive equipment. ELA is performed as an outpatient procedure and does not require the use of an operating theatre, nor does the patient need a general anaesthetic. Doctors must use ultrasound during the procedure to see what they are doing. Some practitioners also perform phlebectomy or ultrasound guided sclerotherapy at the time of endovenous treatment. Follow-up treatment to smaller branch varicose veins is often needed in the weeks after the initial procedure.

References

1. ^ Varicose veins Mount Sinai Hospital, New York (external reference link broken)
2. ^ Merck Manual Home Edition, 2nd ed.
3. ^ NHS Direct
4. ^ Weiss RA, Weiss MA (October 1993). "Doppler ultrasound findings in reticular veins of the thigh subdermic lateral venous system and implications for sclerotherapy". J Dermatol Surg Oncol 19 (10): 947–51. PMID 8408914. http://openurl.ebscohost.com/linksvc/linking.aspx?genre=article&sid=PubMed&issn=0148-0812&title=J%20Dermatol%20Surg%20Oncol&volume=19&issue=10&spage=947&atitle=Doppler%20ultrasound%20findings%20in%20reticular%20veins%20of%20the%20thigh%20subdermic%20lateral%20venous%20system%20and%20implications%20for%20sclerotherapy.&aulast=Weiss&date=1993. 
5. ^ Goldman M. Sclerotherapy, Treatment of Varicose and Telangiectatic Leg Veins. Hardcover Text, 2nd Ed, 1995
6. ^ Ng M, Andrew T, Spector T, Jeffery S (2005). "Linkage to the FOXC2 region of chromosome 16 for varicose veins in otherwise healthy, unselected sibling pairs.". J Med Genet 42 (3): 235–9. doi:10.1136/jmg.2004.024075. PMID 15744037. 
7. ^ Claude Franceschi Physiopathologie Hémodynamique de l'Insuffisance veineuse in Chirurgie des veines des Membres Inférieurs, page 49, 1996, AERCV editions 23 rue Royale 75008 Paris France
8. ^ Campbell B (August 2006). "Varicose veins and their management". BMJ 333 (7562): 287–92. doi:10.1136/bmj.333.7562.287. PMID 16888305. 
9. ^ Curri SB et al. Changes of cutaneous microcirculation from elasto-compression in chronic venous insufficiency. In Davy A and Stemmer R, editors: Phlebology '89, Montrouge, France, 1989, John Libbey Eurotext.
10. ^ "Open Surgery Is Still The Best Technique To Ablate The Great Saphenous Vein," Vascular, Vol. 14 (November 2006), Suppl. 1, p. S. 25
11. ^ Systematic review of foam sclerotherapy for varicose veins.Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Br J Surg. 2007 Aug;94(8):925-36
12. ^ van Rij AM, Chai J, Hill GB, Christie RA (December 2004). "Incidence of deep vein thrombosis after varicose vein surgery". Br J Surg 91 (12): 1582–5. doi:10.1002/bjs.4701. PMID 15386324. 
13. ^ Hammarsten J, Pedersen P, Cederlund CG, Campanello M (August 1990). "Long saphenous vein saving surgery for varicose veins. A long-term follow-up". Eur J Vasc Surg 4 (4): 361–4. doi:10.1016/S0950-821X(05)80867-9. PMID 2204548. http://www.nlm.nih.gov/medlineplus/varicoseveins.html. 
14. ^ claude Franceschi, Cure CHIVA, 1988, Editions de L'Armançon, 21390 Precy-Sous-Thil France
15. ^ [1]
16. ^ Maeso J, Juan J, Escribano J, et al. (November 2001). "Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities". Ann Vasc Surg 15 (6): 661–5. doi:10.1007/s10016-001-0009-8. PMID 11769147. 
17. ^ Zamboni P, Cisno C, Marchetti F, et al. (April 2003). "Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial". Eur J Vasc Endovasc Surg 25 (4): 313–8. doi:10.1053/ejvs.2002.1871. PMID 12651168. 
18. ^ ^{a b} Carandina S, Mari C, De Palma M, et al. (February 2008). "Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial". Eur J Vasc Endovasc Surg 35 (2): 230–7. doi:10.1016/j.ejvs.2007.09.011. PMID 17964822. 
19. ^ ^{a b c} Lurie F (February 2009). "Venous haemodynamics: what we know and don't know". Phlebology 24 (1): 3–7. doi:10.1258/phleb.2008.008055. PMID 19155334. 
20. ^ Goldman M, Sclerotherapy Treatment of varicose and telangiectatic leg vein, Hardcover Text, 2nd Ed, 1995
21. ^ "Veins & Lymphatics," L. K. Pak et al., in Lange's Current Surgical Diagnosis & Treatment, 11th ed., McGraw-Hill,
22. ^ Tisi PV, Beverley C, Rees A (2006). "Injection sclerotherapy for varicose veins". Cochrane Database Syst Rev (4): CD001732. doi:10.1002/14651858.CD001732.pub2. PMID 17054141. 
23. ^ Paul Thibault, Sclerotherapy and Ultrasound-Guided Sclerotherapy, The Vein Book / editor, John J. Bergan, 2007.
24. ^ Padbury A, Benveniste G L, Foam echosclerotherapy of the small saphenous vein, Australian and New Zealand Journal of Phlebology Vol 8, Number 1 (December 2004)
25. ^ Kanter A, Thibault P (July 1996). "Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy". Dermatol Surg 22 (7): 648–52. doi:10.1016/1076-0512(96)00173-2. PMID 8680788. http://openurl.ebscohost.com/linksvc/linking.aspx?genre=article&sid=PubMed&issn=1076-0512&title=Dermatol%20Surg&volume=22&issue=7&spage=648&atitle=Saphenofemoral%20incompetence%20treated%20by%20ultrasound-guided%20sclerotherapy.&aulast=Kanter&date=1996. 
26. ^ http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001732/abstract.html
27. ^ Rigby KA, Palfreyman SJ, Beverley C, Michaels JA (2004). "Surgery versus sclerotherapy for the treatment of varicose veins". Cochrane Database Syst Rev (4): CD004980. doi:10.1002/14651858.CD004980. PMID 15495134. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004980/abstract.html. 
28. ^ Michaels JA, Campbell WB, Brazier JE, et al. (April 2006). "Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial)". Health Technol Assess 10 (13): 1–196, iii–iv. PMID 16707070. http://www.hta.ac.uk/execsumm/summ1013.htm. 
29. ^ William R. Finkelmeier, Sclerotherapy, Ch. 12, ACS Surgery: Principles & Practice, 2004, WebMD (hardcover book)
30. ^ Scurr JR, Fisher RK, Wallace SB (2007). "Anaphylaxis Following Foam Sclerotherapy: A Life Threatening Complication of Non Invasive Treatment For Varicose Veins". EJVES Extra 13 (6): 87–89. doi:10.1016/j.ejvsextra.2007.02.005. 
31. ^ Medical Services Advisory Committee, ELA for varicose veins. MSAC application 1113, Dept of Health and Ageing, Commonwealth of Australia, 2008.
32. ^ Elmore FA, Lackey D (2008). "Effectiveness of ELA in eliminating superficial venous reflux". Phlebology 23 (1): 21–31. doi:10.1258/phleb.2007.007019. PMID 18361266. http://openurl.ebscohost.com/linksvc/linking.aspx?genre=article&sid=PubMed&issn=0268-3555&title=Phlebology&volume=23&issue=1&spage=21&atitle=Effectiveness%20of%20endovenous%20laser%20treatment%20in%20eliminating%20superficial%20venous%20reflux.&aulast=Elmore&date=2008. 
33. ^ Rautio TT, Perälä JM, Wiik HT, Juvonen TS, Haukipuro KA (June 2002). "Endovenous obliteration with radiofrequency-resistive heating for greater saphenous vein insufficiency: a feasibility study". J Vasc Interv Radiol 13 (6): 569–75. doi:10.1016/S1051-0443(07)61649-2. PMID 12050296. http://openurl.ebscohost.com/linksvc/linking.aspx?genre=article&sid=PubMed&issn=1051-0443&title=J%20Vasc%20Interv%20Radiol&volume=13&issue=6&spage=569&atitle=Endovenous%20obliteration%20with%20radiofrequency-resistive%20heating%20for%20greater%20saphenous%20vein%20insufficiency:%20a%20feasibility%20study.&aulast=Rautio&date=2002. 
34. ^ Lurie F, Creton D, Eklof B, et al. (January 2005). "Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up". Eur J Vasc Endovasc Surg 29 (1): 67–73. doi:10.1016/j.ejvs.2004.09.019. PMID 15570274. 
35. ^ Kenneth Myers, An opinion —surgery for small saphenous reflux is obsolete!" Australian and New Zealand Journal of Phlebology, Vol 8, Number 1 (December 2004)

External links

• NHS Direct - Varicose Veins
• Society for Vascular Surgery (U.S.)
• American College of Phlebology

v • d • e Cardiovascular disease: vascular disease · Circulatory system pathology (I70-I99, 440-456) Arteries, arterioles and capillaries Inflammation Arteritis (Aortitis) · Buerger's disease Arterial occlusive disease/ peripheral vascular disease Arteriosclerosis Atherosclerosis (Foam cell, Fatty streak, Atheroma, Intermittent claudication) · Monckeberg's arteriosclerosis · Arteriolosclerosis (Hyaline, Hyperplastic, oxycholesterol, cholesterol, LDL, trans fat) Stenosis Renal artery stenosis · Carotid artery stenosis Other Fibromuscular dysplasia · Degos disease · Aortoiliac occlusive disease · Raynaud's phenomenon/Raynaud's disease · Erythromelalgia Aneurysm/dissection/ pseudoaneurysm torso: Aortic aneurysm (Thoracic aortic aneurysm, Abdominal aortic aneurysm) · Aortic dissection · Coronary artery aneurysm head/neck: Cerebral aneurysm · Intracranial berry aneurysm · Carotid artery dissection · Vertebral artery dissection · Familial aortic dissection Vascular malformation Arteriovenous fistula · Telangiectasia (Hereditary hemorrhagic telangiectasia) Vascular nevus Spider angioma · Halo nevus · Cherry hemangioma Veins Inflammation Phlebitis Venous thrombosis/ Thrombophlebitis primarily lower limb (Deep vein thrombosis) abdomen (May-Thurner syndrome, Portal vein thrombosis, Budd-Chiari syndrome, Renal vein thrombosis) upper limb/torso (Paget-Schroetter disease, Mondor's disease) head (Cerebral venous sinus thrombosis) Post-thrombotic syndrome Varicose veins Varicocele · Gastric varices · Portacaval anastomosis (Hemorrhoid, Esophageal varices, Caput medusae) Other Superior vena cava syndrome · Inferior vena cava syndrome · Venous ulcer · Chronic venous insufficiency · Chronic cerebrospinal venous insufficiency Arteries or veins Vasculitis · Thrombosis · Embolism (Pulmonary embolism, Cholesterol embolism, Paradoxical embolism) · Angiopathy (Macroangiopathy, Microangiopathy) Blood pressure Hypertension Hypertensive heart disease · Hypertensive nephropathy · Essential hypertension  · Secondary hypertension (Renovascular hypertension) · Pulmonary hypertension · Malignant hypertension · Benign hypertension · Systolic hypertension · White coat hypertension Hypotension Orthostatic hypotension vascular navs: anat/physio/dev, noncongen/systemic vasculitis/congen/neoplasia, symptoms+signs/eponymous, proc

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