Varicose veins are dilated, swollen, and coiled veins of the skin that are ordinarily blue or dark purple in appearance. It happens when the valves in veins fail to operate effectively as they should, leading to blood stagnation in the veins. This condition mostly occurs in the legs and particularly in the feet since these are some of the most affected parts of the body when standing or walking. 

Prevalence: 

• General Population: It is evident that varicose veins are common in the population; research indicates that from 20-30 percent of people have the condition. 
• Gender Differences: It is significant to indicate that women are infected more often than men. The frequency in women is approximately 25-33%, and in men it is 10-20%. 
• Age Factor: Varicose veins are more common as people age. 

Venous Valve Dysfunction 

• Valve Incompetence: Leg veins have one-way valves that stop blood from going backward. The veins may grow if blood flows backward and pools due to weakened or broken valves. 
• Reflux: Thus, reflux raises pressure contributed to veins’ further dilatation and valve dysfunctions in the vicious circle. 

Venous Hypertension 

• Increased Pressure: This cause vasodilation, the pooling of blood augment venous pressure or venous hypertension. CVH leads to veins’ dilatation and tortuosity due to pressure overload in the system. 
• Hydrostatic Pressure: Since standing and sitting for more extended periods apply pressure on the veins and increase hydrostatic pressure, venous hypertension is also likely to be worsened. 

Venous Wall Weakness 

• Structural Changes: Chronic venous hypertension and inflammation can compromise the function and morphology of vessels. The vein wall becomes less and less elastic; it becomes stiffer. 
• Inflammatory Response: It damages the pathways of veins, leading to the formation and growth of varicose veins. 

Genetic Predisposition 

• Familial Tendency: The development of varicose veins has a hereditary feature, in 70% of cases, the disease develops if there are such tendencies in the family. 

• Genetics: This is true even if there is no family history of varicose veins, although having a family history also raises the risk. 
• Gender: This condition affects female much as compared to males and has a close relation with hormonal balance (pregnancy, menopause, contraceptive pills). 
• Age: As people age, the valves of the veins also degenerate and hence may lead to varicose veins. 
• Prolonged Standing or Sitting: Sedentary jobs and jobs that engage a person in extended standing can contribute to poor blood circulation. 
• Other Conditions: Some diseases such as chronic venous insufficiency causes varicose veins. 

• Lifestyle Changes: Most symptoms can be resolved by following some precaution measures such as exercising on a regular basis, taking suitable measures for weight reduction or controlling weight, avoiding standing or sitting for long intervals etc. 
• Compression Stockings: These can assist in solving the problems of increasing blood flow and consolidation. 
• Medical Procedures: Sclerotherapy, laser treatments, or surgeries can eliminate or seal the affected veins. 

Age Group: 

Varicose veins may be present in all generational categories but are prevalent in the middle-aged and above 50-year-old population. Women are at a higher risk of getting varicose veins, especially during pregnancy, after menopause, or during their menstrual cycle. 

Inspection 

Palpitation 

Trendelenburg test 

Chronic Venous Insufficiency (CVI) 

Deep Vein Thrombosis (DVT) 

Phlebitis 

Leg Ulcers 

Lymphedema 

Mild Presentation 

• Symptoms: Usual no pain associated with the disorder, but noticeable due to swollen and twisted veins generally on the legs. 
• Cosmetic Concerns: Many people seek treatment primarily for cosmetic reasons. 

Moderate Presentation 

• Symptoms: Leg pain-cramping or burning; leg swelling with pain, especially if they have been standing or sitting for long. 
• Swelling: Some of the most common symptoms are: Swelling particularly in the lower extremities including the legs and ankles is relatively mild to moderate. 

Severe Presentation 

• Symptoms: These include severe pain in the affected area, the swelling which does not subside after some time, and fatigue from the legs. 
• Skin Changes: Hyperpigmentation of the skin around the varicose veins, eczema, or venous dermatitis. 
• Ulceration: The common indicators such as development of venous ulcers especially around the ankle area. 

Conservative Measures: 

• Lifestyle Changes: Finally, strength and endurance should be built up through routine exercise, and the patient should avoid obesity and standing or sitting for a long time. 
• Compression Stockings: These can improve blood flow and reduce the manifestations. 

Minimally Invasive Procedures: 

• Sclerotherapy: A procedure where a solution is injected right into the vein to reduce the size of the blood vessel and block it completely. 
• Endovenous Thermal Ablation: Cohesion is where heat in the form of laser or radio frequency energy is used to close the vein. 
• Mechanochemical Ablation: Coating the surface with a chemical after cracking and or cutting the vein mechanically. 
• Clarivein: Both mechanical disruption technology and sclerotherapy technology are used together. 

Surgical Options (for severe cases): 

• Ligation and Stripping: Small incisions are made to remove the affected vein. 
• Ambulatory Phlebectomy: Small punctures are used to remove smaller varicose veins. 
• Vein Bypass: Rarely used, involves rerouting blood flow around the affected vein. 

Dermatology, General

• Compression Stockings: These are particularly designed to exert pressure on your legs with an aim of assisting veins and leg muscles in pumping blood. 
• Exercise: Daily exercise will also have affective circulation and the following are some of the exercises that focus on the calf muscles. 
• Elevating Legs: Elevating your legs whenever you are resting have a beneficial effect of decreasing swelling and aiding the blood to circulate back to the heart. 
• Weight Management: Losing or at least controlling your weight so you do not exert extra pressure on your veins can help in not worsening the condition of varicose veins. 
• Avoiding Prolonged Standing or Sitting: One should avoid leaning on one leg for long time and switch between standing and sitting from time to time to increase blood flow. 

Dermatology, General

• Polidocanol When administered intravenously it has the effect of damaging the lining of blood vessels, this leads to platelets clumping around the damage. This leads to vessel obliteration that is thereafter replaced by connective-fibrous tissue with time. 
• Sodium tetradecyl sulfate 
  It assists in reducing dilation of swollen veins.
  The solution of sodium tetradecyl sulfate is utilized in the removal of small varicose veins in the lower limbs. 

Dermatology, General

• Sclerotherapy: Administration of a solution in the vein to create a blockage and seal the vein in the process. Such as foam sclerotherapy because it is perfect for the small varicose vein. 
• Ambulatory Phlebectomy: The procedures involve using small incision veins just beneath the skin. It is usually required for bulky varicose veins that cannot be managed by other techniques. 
• Ligation and Stripping: The vein to be blocked is identified and then clamped off (ligated) and then the entire vein is then stripped out through two small cuts. This method is now employed because of newer techniques that do not involve incisions in the patient. 

Dermatology, General

Conservative Management: 

• Lifestyle Changes: The measures that the patient should adopt include exercising more, weight loss, reducing time spent standing/ sitting, and lying down/ raising legs whenever possible. 
• Compression Therapy: Using compression stockings in the promotion of blood circulation, effectively reduces swelling. 
• Medical Management: 
• Medications: Analgesic, which is also an NSAID, to alleviate pain and inflammation. 
• Topical Treatments: Ointments or creams that help decrease itching and other similar symptoms. 

Minimally Invasive Procedures: 

• Sclerotherapy: Injecting a solution into the affected veins to close them off and redirect blood flow. 
• Laser or Radiofrequency Ablation: The process of solidifying through heat energy to close the vein. 
• Surgical Intervention: 
• Vein Stripping: Removing the affected vein through small incisions. 
• Ambulatory Phlebectomy: The procedures involve using small incision veins just beneath the skin. 

Post-Treatment Care: 

• Follow-up: Follow up with the patient to determine whether there is any sign of reoccurrence or any other complication that may be associated with the disease. 
• Continued Lifestyle Changes: Lifestyle changes should be enacted to reduce the chances of getting new varicose veins.