varicose vein, a tortuous, dilated vein with incompetent valves. Causes include congenitally defective valves, thrombophlebitis, pregnancy, and obesity. Varicose veins are common, especially in women, and are usually painless. The saphenous veins of the legs are most often affected. Elevation of the legs and use of elastic stockings are frequently sufficient therapy for uncomplicated cases. Ligation of the vein above the varicosity and removal of the distal part of the vessel may be indicated for more severe cases if deeper vessels can maintain the return of venous blood. Injection of sclerosing solutions helps prevent or treat postphlebitic syndrome. ▪ OBSERVATIONS: Initially the vein may be palpated but invisible, and the individual may have a feeling of heaviness in the legs that gets worse at night and in hot weather. A dull aching, burning, and cramping also occur after prolonged standing or walking, during menses, when fatigued, and at night. Over time the veins can be seen as dilated, purplish, and ropelike. Venous insufficiency and venous stasis ulcers are the two most common complications. Initial diagnosis is made by inspection and palpation and is checked by a manual compression test that reveals a palpable impulse. A Trendelenburg’s test can help pinpoint the location of incompetent valves. Plethysmography and duplex ultrasound scans can be used to detect venous backflow. ▪ INTERVENTIONS: Conservative treatment involves elevation and rest of affected extremity, application of lightweight compression hosiery, and avoidance of prolonged standing. Sclerotherapy may be used for removal of unsightly superficial varicosities. Stripping and ligation may be indicated for chronic venous insufficiency, recurrent thrombophlebitis, and persistent varicosities that are painful or ulcerated and are not responsive to conservative treatment. ▪ PATIENT CARE CONSIDERATIONS: Long-term management of varicosities is directed at improving circulation and preventing stasis, relieving discomfort, and preventing complications. Instruction is given to avoid prolonged standing and sitting and to make frequent position changes. Restrictive and/or occlusive clothing should be avoided, and lower extremities should be periodically elevated above the heart. Compression stockings should be applied while lying down and before rising in the morning. A regular exercise aerobic program should be instituted to promote circulation, and weight reduction is advocated if obesity is a problem.
