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  1. M-C Nogaro, core surgical trainee,
  2. D J Pournaras, specialist registrar general surgery,
  3. C Prasannan, general practitioner,
  4. A Chaudhuri, consultant vascular surgeon
  1. 1Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, UK
  1. Correspondence to: M-C Nogaro marie.nogaro02{at}imperial.ac.uk
  • Accepted 3 October 2011

A 55 year old woman presents with a history of tortuous veins on both legs and a related ache towards the end of the day. She finds these veins unsightly and would like to know whether she can have them treated.

What you should cover

  • Varicose veins are very common: 40% of men and 32% of women aged 18-64 years have this condition.1

  • Common presenting complaints are “heavy legs”, swelling, restless legs, cramps, itching, and tingling,2 but these symptoms are often unrelated to the presence of varicose veins.2

  • Document risk factors such as increasing age, family history, obesity, and occupational history associated with prolonged standing.3 Varicose veins may first become apparent during pregnancy and the risk increases with parity.1 3

  • Ask about red flag symptoms such as weight loss and rectal bleeding where varicose veins may be due to a pelvic or abdominal mass.

  • Ask about previous treatment of varicose veins and outcome. Document a history of deep vein thrombosis or thrombophlebitis, where varicose veins could be acting as collaterals in the presence of deep vein obstruction.3 Document symptoms of arterial insufficiency …

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