VARICOSE VEINS

   Varicose veins and stasis dermatitis of the ankle

ICD-9: 454.x

Description

Varicose veins are enlarged, twisted, superficial veins. They may occur in almost any part of the body, but most frequently they occur in the lower legs, involving the greater and lesser saphenous veins. The condition is most common after age 50 and in obese persons, affecting more women than men. Varicose veins tend to be inherited.

Varicose veins and stasis dermatitis of the ankle

FIGURE. Varicose veins and stasis dermatitis of the ankle. (From Thomas, CL [ed]: Taber’s Cyclopedic Medical Dictionary, ed 21. FA Davis, Philadelphia, 2009, p 2437, with permission.)

Etiology

Defective or damaged valves in the veins prevent the blood from flowing freely toward the heart. This buildup of pressure in the superficial veins causes varicosities. Varicose veins may be due to an inherited defect or to venous diseases. They also may be produced by conditions such as pregnancy or jobs requiring prolonged standing or heavy lifting. Many factors can aggravate the situation.

Signs and Symptoms

Clients may be asymptomatic even though the varicose vein condition is severe. Quite frequently, however, the affected veins are visually evident. Characteristic symptoms with varicose veins of the legs include dull, aching heaviness or a feeling of fatigue after standing. Cramping may occur, followed by edema and stasis pigmentation, a tan discoloration of the skin.

Diagnostic Procedures

In most cases, visual observation may be all that is necessary. Phlebography may be performed for diagnosis. Doppler ultrasonography detects possible backflow in deep or superficial veins.

Treatment

The use of elastic stockings, a moderate exercise program, and avoidance of prolonged periods of standing or lifting are recommended initially. Injection of a sclerosing agent into small vein segments is useful for destroying small spider veins but will not work on varicose veins. Severe varicose veins may require stripping and ligation, but clients must have patent deep venous channels. A procedure known as endovenous laser therapy destroys the vein with a laser. The procedure is usually performed in an outpatient setting under local anesthesia, taking about 40 minutes. The small laser, guided by ultrasound, is passed into the vein. When it is fired at multiple locations, the vein is destroyed. Radiofrequency ablation is a similar technique with an endovascular laser, but it uses heat to destroy the vein.

Complementary Therapy

It is recommended that clients elevate the legs as much as possible, wear support stockings, lose weight, and avoid alcohol. They should not massage directly over the varicose veins.

CLIENT COMMUNICATION

Tell clients not to cross their legs when sitting; rather, they should cross their ankles. Wearing support hose and getting up frequently to walk is helpful. Remind clients to sit with their legs elevated if possible.

Prognosis

The prognosis is good; however, further varicose veins may develop, requiring additional treatment.

Prevention

Prevention of varicose veins includes avoiding prolonged standing or lifting, avoiding constrictive clothing, and elevating the legs when possible. If obesity is a problem, have the client begin a plan to lose weight.