Varicose Veins

Varicose veins are superficial veins that have become enlarged, elongated, and twisted. The central problem is venous reflux: an incompetent vein wall or valve allows blood to move backward instead of returning efficiently toward the heart. Gravity then increases pressure in the dependent leg, especially during standing and walking. This sustained ambulatory venous hypertension stretches the vein further, creating a cycle of dilation and worsening valve closure. [1] Common risks include increasing age, pregnancy, overweight or obesity, prolonged standing or sitting, physical inactivity, and a family history of varicose veins. These factors increase venous pressure, reduce the effectiveness of the calf-muscle pump, or reflect inherited weakness in the vein wall or valves. [4] The disease is not limited to visible veins. Persistent venous hypertension can produce dependent oedema, then inflammatory skin changes such as pigmentation, eczema, lipodermatosclerosis, atrophie blanche, and corona phlebectatica. A healed venous ulcer is classified as C5, while an active venous ulcer is C6. The 2020 CEAP update identifies corona phlebectatica as C4c and uses an “r” modifier for recurrence, such as C2r for recurrent varicose veins....