VARICOSE DISEASE :

It is a progressive and benign disorder, which can however lead to certain complications.

According to the stage of the disease, the patient complains about:

• Heaviness and pain in the legs: the problem can be permanent or intermittent, start at any time during the day and worsen in the evening. It affects usually both legs, is aggravated by standing or heat exposure. Sitting or lying down with legs elevated alleviates the condition.
  
  
• Cramps: very frequent, cramps have a painful, sudden onset with feelings of constriction, usually in the calves or big toes. These cramps can occur day or night and be very debilitating. They tend to occur while resting, and improve with walking.
  
  
• Restlessness: Restlessness is a feeling of discomfort in the lower extremities which forces the patient to shake his legs, squeeze the calf muscles, move his feet and seek cold spots. This phenomenon, also called "restless legs syndrome", appears while lying still, especially at night and in a warm bed. The patient will want to get up, apply venotonic creams or spray cold water on his legs.

Upon clinical examination, the doctor will notice:

• Oedemas:
  
  Oedemas of the lower extremities are located initially around the internal and external ankle malleoli, then as the disease progresses, spread to the whole ankle, foot, even the lower third of the calf. Oedemas are the result of an infiltration of the cutaneous and subcutaneous tissues by an interstitial fluid rich in proteins. Oedemas cause the inflammation of the teguments, itself a source of pain.
  The swelling of the extremities increases at the end of the day and with heat, usually regresses in the morning at wake-up time or after a period of rest with legs flat.
  
  
• Thread veins:
  Permanent enlargements of intra-dermal venules, thread veins are found on the calves or thighs with a tendency to spread spontaneously in size and volume. It is usually just a cosmetic problem but can also be a sign of underlying varicose veins. They are most frequently found on the external side of the thighs and on the back of the knee, but also sometimes on the rest of the body, chest, stomach, shoulders, face.
  
  
  There are two types of thread veins:
  - Blue thread veins tied to venous stasis (or stagnation)
  - Red thread veins, often isolated and sometimes linked to a trauma
  or local inflammation
  
  
• Varicose veins
  
  
  
  Ampular enlargements of superficial veins, varicose veins are not always visible. The standing position often causes their dilatation. When visible, they appear as small, soft, generally painless bulges, sometimes looking like bunches. They are the sign of advanced venous insufficiency, often with valve incompetence. Varicose veins are located on the saphenous veins or on their tributaries, but can also be vulvar, perineal or abdominal. Haemorrhoids also belong to that category.
  They are not just a cosmetic problem, but a source of possible complications.
  
  

COMPLICATIONS OF VARICOSE VEINS:

Venous insufficiency is a progressive disease, with symptom having the potential to worsen and impact the patientπs quality of life. Pain can intensify, varicose veins can rupture or cause superficial thrombosis. At first intermittent, oedemas can become permanent and increase in size, covering progressively the ankle and foot bones; cutaneous and subcutaneous tissues fill with fluids, which can lead to skin complications.

a) eczema

The itchy skin lesions of eczema (red, dry, scaling skin) are usually found in the lower extremities but can also spread to the entire body (chest, arms), especially if there is an underlying allergic condition.

b) Hypodermatitis

First stage	Very developed stage

A quasi-permanent oedema of the lower third of the leg, it triggers an inflammation of the teguments, which leads to retractile fibrosis of the subcutaneous tissues. This fibrosis progresses in painful spurts that can cause a loss of articular mobility in the ankle. In full-blown fibrosis, the skin retracts and thickens. In extreme cases, it takes on the look of a roosterπs calf (see picture). This stage is irreversible.

c) Brown dermatitis Brown dermatitis involves permanent brown spots, initially found in the lower third of the leg, sometimes on the calf. The spots are caused by blood pigment deposits in the dermis. This condition progresses slowly.

d) White atrophy
White atrophy is found at a more advanced stage and consists of whitish spots with poor vascularisation. The spots are often surrounded with thread veins and are found near the ankles. These areas are prone to ulcers.

e) Rupture of a varicose vein

• 1) External rupture of a varicose vein
  either spontaneously or after a trauma, even a small one, it usually occurs on a protruding, purple area typical of a very superficial varicose vein (see picture). The external varicose haemorrhage is very impressive but seldom serious. The patient should lie down immediately, raise his leg and apply direct pressure to the bleeding area. The blood flow will stop immediately. A tourniquet should absolutely not be used.
  
  
  very superficial varicose veins, significant risk of rupture
  
  
• 2) Rupture of a varicose vein without external signs
  As a deep vein tears, sometimes even after a minimal effort, a haematoma forms rapidly. There is a sharp, sudden pain, like a "whiplash", and an oedema can appear on the ankle a few hours later. A duplex-scan is necessary to confirm the diagnosis and rule out phlebitis.
  
  

f) Superficial phlebitis

Superficial phlebitis occurs when there is a blood clot in a varicose vein. It looks like a red, hot, painful cord located along the vein path, and occurs in advanced varicose areas. Here, too, a Duplex-scan is necessary to check the deep venous system. 30% of superficial thromboses lead to complications or are linked to deep phlebitis.

g) Ulcers

Ulcers appear spontaneously or after a trauma, even a small one, in a skin weakened by poor blood circulation. They are of a venous origin in 70% of cases and arterial origin in 28% of cases.
Ulcers of venous origin are most often located on the external side of the ankle or the leg. Their size and depth are variable, and their evolution capricious. Ulcers require therapeutic treatment including mandatory compression with elastic bandages and tetanus shots.