Clinical Case Database / Category: Patient Management

Varicose veins

Publication details

Dr GR Nana MB ChB, Mr Trevor Yeung MA, MBBChir, MRCS, DPhil, Mr Timothy Magee MB Chb, MD, FRCS
Foundation Years Journal, volume 7, issue 10, p.42 (123Doc Education, London, November 2013)

Abstract

Varicose veins are dilated, tortuous subcutaneous veins that are >3mm in diameter when measured in the upright position. (1) In Western populations, the prevalence for varicose veins is >20% with an estimated 5% having associated signs of chronic venous insufficiency (CVI). Working in hospital or community, varicose veins and CVI will be encountered and the foundation doctor should have knowledge of their distribution, recognise complications such as skin damage and be aware of management options when advising or consenting patients. This case based discussion aims to cover aspects of good clinical care as stated in the foundation curriculum and update the reader on
evidence based guidelines.

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Authors

Dr GR Nana MB ChB

Lead Author, CT1 Vascular Surgery
Royal Berkshire Hospital HS Trust, London Road, Reading, RG1 5AN
gaelromy@gmail.com

Mr Trevor Yeung MA, MBBChir, MRCS, DPhil

Speciality Registrar (Vascular & Upper GI Surgery)
Royal Berkshire Hospital
yeungtmy@gmail.com

Mr Timothy Magee MB Chb, MD, FRCS

Consultant Vascular Surgeon
Royal Berkshire Hospital
tim@magee.uk.com

References

1. Kistner R, Eklof B. Classification and etiology of chronic venous disease. In: Gloviczki P, editor. Handbook of venous disorders: Guidelines of the American Venous Forum. 3rd ed. London: Hodder Arnold; 2009. p. 37 – 46.
2. Labropoulos N, Giannoukas AD, Delis K. et al. Where does venous reflux start? J. Vasc. Surg. 1997 Nov;26(5):736–42.
3. Kim J, Richards S, Kent PJ. Clinical examination of varicose veins--a validation study. Ann R Coll Surg Engl. 2000 May;82(3):171–5.
4. London NJM. Duplex ultrasonography and varicose veins. Br J Surg. 2007;94(5):521–2.
5. Gloviczki P, Comerota AJ, Dalsing MC. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J. Vasc. Surg. 2011 May;53(5 Suppl):2S–48S.
6. Amsler F, Blättler W. Compression therapy for occupational leg symptoms and chronic venous disorders - a meta-analysis of randomised controlled trials. Eur J Vasc Endovasc Surg. 2008 Mar;35(3):366–72.
7. Layden J, Michaels J, Bermingham S. et al. Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance. BMJ. 2012;345:e4947.
8. Michaels JA, Campbell WB, Brazier JE. et al. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess. 2006 Apr;10(13):1–196, iii–iv.
9. Subramonia S, Lees TA. The treatment of varicose veins. Ann R Coll Surg Engl. 2007 Mar;89(2):96–100.
10. Nesbitt C, Eifell RK, Coyne P. et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2011;(10):CD005624.
11. Lurie F, Creton D, Eklof B. et al. Reprinted article “Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up.”Eur J Vasc Endovasc Surg. 2011 Sep;42 Suppl 1:S107–113.
12. Nicolini P. Treatment of primary varicose veins by endovenous obliteration with the VNUS closure system: results of a prospective multicentre study. Eur J Vasc Endovasc Surg. 2005 Apr;29(4):433–9.
13. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol. 2003 Aug;14(8):991–6.
14. Galland RB, Magee TR, Lewis MH. Innovations in varicose vein treatment. Topical issues in vascular surgery, 2005. Kerala, India: Research Signpost; 2005.
15. Rasmussen LH, Lawaetz M, Bjoern L. et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug;98(8):1079–87.

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.