Intended for healthcare professionals

Clinical Review ABC of arterial and venous disease

Varicose veins

BMJ 2000; 320 doi: (Published 20 May 2000) Cite this as: BMJ 2000;320:1391
  1. Nick J M London,
  2. Roddy Nash

    Varicose veins are tortuous, twisted, or lengthened veins. Unless the enlargement is severe, size alone does not indicate abnormality because size can vary depending on ambient temperature and, in women, hormonal factors. In addition, normal superficial veins in a thin person may appear large, whereas varicose veins in an obese person may be hidden. Varicose veins can be classified as trunk, reticular, or telangiectasia. Telangiectasia are also referred to as spider veins, star bursts, thread veins, or matted veins. Most varicose veins are primary; only the minority are secondary to conditions such as deep vein thrombosis and occlusion, pelvic tumours, or arteriovenous fistulae.

    Trunk varices are varicosities in the line of the long (top, left) or short (top, right) saphenous vein or their major branches. Reticular veins (arrow, bottom) are dilated tortuous subcutaneous veins not belonging to the main branches of the long or short saphenous vein, and telangiectasia (bottom) are intradermal venules <1 mm

    Incidence and prevalence

    A study of people aged 35 to 70 years in London in 1992 concluded that the prevalence of varicose veins in men and women was 17% and 31% respectively. Although varicose veins have traditionally been considered commoner in women, a recent study from Edinburgh of people aged 18 to 64 years found that the prevalence of trunk varices was 40% in men and 32% in women. Over 80% of the total population had reticular varicosities or telangiectasia. There are few studies on the incidence of varicose veins; however, the Framingham study found that the two year incidence of varicose veins was 39.4/1000 for men and 51.9/1000 for women.

    Pathophysiology and risk factors

    The theory that varicose veins result from failure of valves in the superficial veins leading to venous reflux and vein dilatation has been superseded by the hypothesis that valve incompetence follows rather than precedes a change in …

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