Varicose Veins: Symptoms and Diagnosis

What are the signs and symptoms of varicose veins?

In most patients, symptoms do not manifest until evident venous stasis and edema occur. 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.

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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;
Increased temperature localized to the area where the varicose vein is present;
Itchy legs, particularly in the lower area and near the ankle;
Appearance of swelling in the ankles and / or feet.

The reported disorders are often due to complications of varicose veins: initial skin changes of eczematous type (redness and itching) are observed which progressively worsen until reaching the varicose ulcer (bleeding lesion).
In other cases the patient may develop superficial phlebitis or have varicosity rupture hemorrhages, which frighten him enormously but which, fortunately, are always easily controlled.
Due to the altered circulation, the tissues of the affected parts are particularly sensitive to lesions, therefore infections and wounds heal slowly and tend to turn into chronic varicose ulcers (which cannot be cured definitively).
Particularly women are conditioned by the aesthetic problem connected not only to the gibbosities of the varices that protrude conspicuously, but also to the simple presence of small varicosities (reticular varices) and telangiectasias (capillaries) that clearly mark the skin.

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Two very simple maneuvers to be carried out at home are also widely used, but extremely useful:

Trendelenburg test

The patient is placed in a supine position (lying on his stomach upwards) and his limb was used, thus emptying the superficial venous circulation.
Then a lace is placed at the root of the thigh (blocking the blood which cannot descend), it is put in an upright position (upright position) and finally the lace is removed.
If the blood flows back from top to bottom it means that there is an incontinence of the valves of the perforating vein system so that the blood flows back from the deep to the superficial circulation. If, on the other hand, the varices no longer fill, we are certainly dealing with primitive varices. from incontinence of the anatomical venous area of junction between Safena and Femoral, at the root of the thigh.

Perthes test

The patient in standing position, with normal turgor of the varicose veins, is again applied a lace to the root of the thigh and he is made to walk. Walking causes blood to be squeezed from the superficial to the deep system. If the varicose veins are emptied, we are certainly faced with a free deep venous circulation, because the blood from the superficial circulation flows there without problems. So we are dealing with a primitive varicose syndrome
If the varices do not empty, we are faced with an obstructed deep venous circulation and a varicose syndrome secondary to other causes.
If there are doubts about the presence of valvular incontinence or about the primitiveness of varicose veins, it is advisable to perform an echo color Doppler examination, which is an instrumental examination with which venous regurgitation can be reliably studied; it is thus possible to visualize the valvular incontinence of the superficial venous system, accentuated by maneuvers such as that of Valsalva (increased pressure inside the abdomen) or compressive, which are sometimes required of the patient during the examination to highlight the defect.