Clinical Review

Varicose veins and their management

BMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.333.7562.287 (Published 03 August 2006) Cite this as: BMJ 2006;333:287
  1. Bruce Campbell (bruce.campbell@nice.org.uk), consultant surgeon and professor1
  1. 1 Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter EX2 5DW
  • Accepted 16 June 2006

Introduction

Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. Their valves are usually incompetent so that reflux of blood occurs, and the resulting venous hypertension can cause symptoms. Varicose veins are widely seen as medically unimportant and deserving low priority for treatment. They are common, affecting nearly a third of adults in Western societies, and few people with varicose veins are ever harmed by them. However, they cause concern and distress on a large scale, most of which can be dealt with by good explanation and reassurance, or by a variety of treatments which are evolving rapidly at present. Patients can now be referred for more precise assessment and a greater range of therapeutic options than ever before.

Who gets varicose veins?

A large UK population study has shown age adjusted prevalences of 40% in men and 32% in women, although women more often present for treatment.1 The age of onset varies; some people develop varicose veins in their teens, but prevalence rises with age. Varicose veins often appear first in pregnancy, and further pregnancies can make them worse. A family history is common,1 but people should be reassured that having close relatives with severe symptoms from varicose veins or ulcers does not confer any great likelihood that they will have similar problems.

Data sources and selection criteria

This review is based on three main sources:

  • A personal archive of publications accumulated over 20 years of special interest, studies, and writing on varicose veins

  • Conversations with specialist vascular colleagues—particularly about the potential advantages and disadvantages of the newer treatments, indications for their use, and their place in the management of varicose veins

  • A Medline search for important recent publications.

Summary points

Most people with varicose veins are never harmed by them—good explanation and reassurance are fundamental

Ultrasound techniques (hand held …

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