They are dilated, torturous, elongated veins in the leg.

There are three categories of venous insufficiency

1.                Congenital venous insufficiency is comprised of predominantly anatomic variants that are present at birth. Examples of congenital venous anomalies include venous ectasias, absence of venous valves, and syndromes such as Klippel-Trenaunay syndrome.

2.                Primary venous insufficiency is an acquired idiopathic entity. This is the largest clinical category and represents most of the superficial venous insufficiency encountered in the office.

3.                Secondary venous insufficiency arises from a post-thrombotic

Salient features

•           Heaviness, discomfort, and extremity fatigue legs.

•           Pain is characteristically dull, does not usually occur during recumbency or early in the morning, and is exacerbated in the afternoon, especially after periods of prolonged standing.

•           Swelling

•           The discomforts of aching, heaviness, and/or fatigue are usually relieved by leg elevation or elastic support.

•           Cutaneous burning, termed venous neuropathy, can also occur in patients with advanced venous insufficiency.

•           Pruritus occurs from excess hemosiderin deposition and tends to be located at the distal calf or in areas of phlebitic varicose branch segments.

•           Discoloration, ulceration in the feet

Duplex ultrasonography helps in localization of perforators, saphenous-femoral, saphenous-popliteal incompetence, to rule out DVT.

Management

Indications for treating varicose veins are: Cosmesis, symptoms refractory to conservative therapy, bleeding from a varix, superficial thrombophlebitis lipodermatosclerosis, venous stasis ulcer.

A. Conservative

•           Compression treatment- to use gradient compression stockings that provide 30-40- or 40-50-mm Hg of compression at the ankle, with gradually decreasing compression at more proximal levels of the leg

•           Elevation of limbs- relives edema.

•           Drugs like Cacium dobsilate (500 mg BD), Diosmin (450 mg BD). Benefits of all these drugs are doubtful.

Surgical

•           Sclerotherapy

•           Trendelenburg operation -High ligation, division, stripping of the GSV

•           Endovenous thermal ablations- Endovenous LASER oblations (EVLA) or Radiofrequency ablation (RFA)

Postoperative management

1.          Compression bandaging immediately following stripping or avulsion of veins. i bandages by compression stocking after 2 days.

2.          Limb elevation and encourage the patient to walk with compression stockings after fire' of dressing 48 hours after operation.

3.          Postoperative pain is controlled with dextropropoxyphene or NSAIDs.

C. Patient education

•           Certain Do's are leg exercise, leg elevation, wear stockings and drinking 4-5 L of fluids in a day.

•           Certain Don'ts are hot bath, exposure to extremes of temperature, pregnancy, contraceptivepil oestrogens, long journeys (flight).

•           Teach the patient leg exercises -frequent movements of toes and heels, sarvangasan or shirshasan, and elevation of foot end of the bed about 6 inches by putting a block of wood or 2 bricks under foot end of be and to avoid prolonged standing or dangling legs down.