Varicose Veins: Symptoms and Diagnosis

What Is Varicose Veins: Symptoms and Diagnosis

In most patients, symptoms do not occur until venous stasis and edema are evident. Only at this point, the patient begins to feel a sense of heaviness in the limb, especially in the evening and will notice an edema that begins in the area around the  malleolus , especially the internal one.

What Are The Signs And Symptoms Of Varicose Veins?

Furthermore, in correspondence with varicose veins there is often an area in which a sensation of heat is perceived ( hyperthermia ), sometimes accompanied by a strong sense of  itching .
Briefly summarizing, the main and most common symptoms of varicose veins consist of:

  • Feeling of heavy legs;
  • Pain and/or onset of cramps in the lower limbs;
  • Appearance of very visible enlarged veins;
  • Increase in temperature localized to the area where the varicose vein is present;
  • Itching in the legs , especially in the lower area and near the ankle;
  • Appearance of swelling in the ankles and/or feet .

The reported disturbances are often due to the  complications of varicose veins: initial eczematous -type  skin alterations  (redness and itching) are observed   which progressively worsen until reaching  varicose ulcer (bleeding lesion) In other cases the patient may develop  superficial phlebitis  or have  bleeding from rupture of varicosities, which frightens him enormously but which, fortunately, are always easily controllable. Due to the impaired circulation, the tissues of the affected parts are particularly sensitive to injury, thus infections and  wounds heal  
slowly and tend to turn into chronic (non-healable) varicose ulcers.
Women in particular are conditioned by the aesthetic problem connected not only to the humps of the varicose veins which protrude conspicuously, but also to the mere presence of small varicosities (reticular varices) and  telangiectasias  (  capillaries ) which mark the skin in a conspicuous way .


How Are Varicose Veins Studied And Diagnosed?

The diagnosis of varicose disease is generally made on the basis of the clinical examination alone: ​​the patient is placed upright and the entire limb is examined, both anteriorly and posteriorly. Particular attention must be paid to the region of the internal malleolus, the initial site of the edema. The varicose vein is palpated throughout its extension; it has an elastic consistency different from that of the surrounding tissue, is easily compressible and offers minimal resistance .
Also widely used are two very simple maneuvers to carry out even at home, but extremely useful:

Trendelenburg Test

The patient is placed in supine position (lying on his stomach) and the limb is lifted, thus emptying the superficial venous circulation.
Then a string is placed at the root of the thigh (blocking the blood which thus cannot descend), he is placed in orthostatism (standing position) and finally the string is removed.
If the blood flows from top to bottom it means that there is an incontinence of the valves of the system of the perforating veins so that the blood flows from the deep circle to the superficial one. If, on the other hand, the varicose veins no longer fill up, we are certainly dealing with primitive varicose veins from incontinence in the venous anatomical area of ​​junction between the  saphenous  and femoral veins, at the root of the thigh.

Perthes Test

The standing patient, with normal varicose vein turgor, is reapplied with a tourniquet to the root of the thigh and made to walk. Walking determines the squeezing of blood from the superficial to the deep system. If the varicose veins are emptied, we are certainly dealing with a free deep venous circulation, because the blood from the superficial circulation flows there without problems. So we are dealing with a   primary varicose syndrome
If the varices do not empty, we are dealing with an obstructed deep venous circulation and a secondary varicose syndrome to other causes.
If there are doubts about the presence of valvular incontinence or the primitivity of the varicose veins, it is advisable to perform a echo color Doppler examination, which is an instrumental examination   with which venous regurgitation can be studied reliably; it is thus possible to visualize the valvular incontinence of the superficial venous system, accentuated by maneuvers such as that of  Valsalva  ( increase of pressure inside the abdomen) or compressions, which are sometimes requested of the patient during the examination to highlight the defect. 

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