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Department
of Podiatry - Vascular Assessment
Varicosities
Varicosities
is an umbrella term for the changes that occur in a vein which ultimately
lead to varicose veins. A varicose vein is a tortuous, dilated, lengthened
vessel caused by increased pressure within that vessel. The great saphenous
vein is most commonly effected (Baele, 1992).
The causes of the increased pressure are numerous, and can be divided
into primary and secondary aetiologies.
Primary varicosities, whilst they can be unsightly, may never
result in further problems with venous insufficiency. Causes include
a hereditary predisposition, ie. if your mother or especially your father
has varicose veins you will be more likely to develop them. Also if
occupation or leisure results in prolonged standing with absence of
muscle pump activation the increased hydrostatic pressure and venous
stasis will cause dilation and lengthening. There may also be merit
to the theory that taller people are more prone to variscosities (LTU
PM331 manual).
Secondary varicosities, also unsightly, are of greater concern
because the underlying aetiology may also cause other pathologies. They
may be due to an increase in deep venous pressure, valvular incompetence,
and multiple congenital arterio-venous fistulas (LTU PM331 manual).
• Deep venous pressure increases may be due to extreme muscle effort;
hormonal changes due to pregnancy; obesity due to the increased blood
volume required to supply the excess adipose tissue; tight restrictive
clothing; and venous obstruction from DVT, abdominal mass, leg trauma,
embolism etc.
• Valvular incompetence is considered the most likely cause of varicosities
(Nelson, 1992), and may be due to either a congenital absence of deep
vein and perforator valves; or incompetent valves due to trauma from an
underlying condition such as stasis, thrombosis, and recanalisation.
• Multiple Congenital Arterio-Venous Fistulas is a condition where
a naturally high number of anastomoses that connect the arterioles to
the venules is present, resulting in a transfer of pressure from the arteries
to the veins, and thus distention and lengthening.
As mentioned above, varicose veins don’t themselves often cause damage,
however they may contribute to the development of venous
ulcers, oedema etc., and their underlying
aetiology may also cause further problems. Again, they are a good indicator
of venous insufficiency, however it is important to determine the cause,
usually in the course of history taking. In themselves they are often
more of a cosmetic issue with the patient and may be removed through surgery
by a vascular physician (Anderson, 1999, Cotran, 1999).
Varicose
veins around the foot and medial leg.
Varicose
veins around the knee and thigh.
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