In varicose veins, the veins are twisted and abnormally enlarged, with valves that leak and are incompetent. The condition is most commonly seen in the lower extremities, involving the lesser and greater saphenous veins.

The cause is unknown, but varicosities result from venous stasis. The condition is also associated with thrombophlebitis, pregnancy, tumors, occupations that require long hours of standing, or a congenital weakness of the valves in the veins.

Symptoms range from mild to severe and include: a feeling of leg heaviness, leg cramps at night, dull ache in the legs after many hours of standing, leg aches during menstruation, leg and ankle edema, feelings of fatigue, and brownish gray discoloration of the skin on the calves and ankles from stasis. Stasis ulcers may form after discoloration.

A duplex scanner can locate incompetent valves, and Doppler ultrasound can detect reflux and obstruction. The ankle-brachial index measurement is helpful (see Diagnostic Code: 7114 Arteriosclerosis obliterans).

The measures used to treat the condition are as follows:

• Non-surgical: The veins are supported by elastic stockings, the legs are elevated whenever possible, and a regular exercise schedule is established. If an ulcer is present, medication can be made from the patient's own blood platelets to heal skin ulcers.

• Surgical: The veins are removed or interrupted by ligation. However, venous segments that are not incompetent are not removed. Later in the patient's life, these segments may be needed for artery grafts when total vein strippings are being reconsidered.

• Sclerotherapy: The procedure is an alternative to vein stripping surgery. A sclerosing medication is injected into affected portions of the veins, and fibrosis is produced. Compression is applied, and the vein is obliterated.

Some leg ulcers will need surgical skin grafting if medical compression and other therapies are not successful. In addition, with sclerotherapy, there are possible complications resulting in tissue necrosis, infection, or phlebitis.