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Varicose veins

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VOL: 98, ISSUE: 48, PAGE NO: 28

AETIOLOGY AND RISK FACTORS

AETIOLOGY AND RISK FACTORS
Varicose veins are dilated veins that have lost their elasticity. The valves within the veins have become ineffective resulting in dilation, a reversal of blood flow, and stasis.

The condition is more common in women and can be caused by trauma, obesity, heredity, pregnancy, thrombosis, occupations requiring prolonged periods of standing, or combinations of these factors.

Varicose veins are often found in the lower legs, as leg vein valves endure the greatest pressure. The great and small saphenous veins and the anterior tibial veins are commonly affected. Varicose veins are also found in the rectum (haemorrhoids) and lower oesophagus (oesophageal varices).

SIGNS AND SYMPTOMS
Veins appear swollen and raised above the skin and may be twisted and bulging or cord-like. They are dark purple or blue in appearance.

The veins can enlarge over time, causing swelling in the legs and feet and may make the muscles feel fatigued and heavy. The surrounding skin may also feel hot and itchy. The affected vein and surrounding tissue can become inflamed and varicose ulcers may develop.

DIAGNOSIS
- Simple examination.

- Ultrasound scan.

- Doppler ultrasound.

- Occasionally a more detailed scan or X-ray may be needed.

TREATMENT AND THERAPIES
- Surgical ligation and stripping.

- Sclerotherapy.

- Laser therapy.

- Use of support/antiembolism stockings/tights.

- Promotion of circulation via exercise.

- Avoidance of prolonged standing, sitting, or crossing of legs.

- Deep breathing assists venous return.

SPECIFIC NURSING IMPLICATIONS
- For the non-surgical patient, the emphasis is on self-care measures (see treatment and therapies). Those that increase venous return will also help to decrease pain.

- For the postoperative patient: bed rest in the first 24 hours, followed by short ambulatory periods at regular intervals. Pressure bandaging from surgery will be replaced with elastic stockings, which should be worn for three to four weeks after surgery.

- Patients having bilateral varicose vein surgery usually have an overnight stay. Postoperative problems can include discomfort around the wounds, and soreness and bruising to the thigh as a result of stripping out the main vein down the inside of the leg. Pain is managed with simple to moderate analgesia and positional changes.

RESEARCH AND DEVELOPMENT
The National Research Register is a database of ongoing and recently completed research projects. It includes many articles on varicose veins. The NRR's search facility can be accessed via the Department of Health's website (address below).

WEBSITES
US National Library of Medicine: www.nlm.nih.gov/medlineplus/varicoseveins.html

University of Nottingham Greenfield Medical Library Nursing, Midwifery and Allied Health Professions (NMAP) vascular nursing gateway:

www.nmap.ac.uk/browse/rcn/detail/8427.html

Department of Health - research and development:

www.doh.gov.uk/research

FURTHER READING
Linton, A.D. et al (eds) (2000)Introductory Nursing Care of Adults. Philadelphia, PA: WB Saunders.

Clancy, J., McVicar, A.J. (eds) (2002)Physiology and Anatomy. A Homeostatic Approach. London: Arnold.

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