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var·i·cose vein(var'i-kōs vān)
The development of varicose veins of the legs is promoted and aggravated by pregnancy, obesity, genetics, chronic constipation, straining at stool, and occupations requiring prolonged standing. Esophageal varices are caused by portal hypertension that accompanies cirrhosis of the liver or mechanical obstruction and occlusion of hepatic veins.
Most varicose veins of the legs are asymptomatic, although they may be cosmetically undesirable. Esophageal varices and hemorrhoidal varices may bleed profusely. See: illustration
In hemorrhage, elevation of the extremity and firm, gentle pressure over the wound will stop the bleeding. The patient should not be permitted to walk until the acute condition is controlled. Sclerotherapy, rubber band ligation, or octreotide may be used to control bleeding caused by hemorrhage from esophageal varices.
The patient with lower extremity varicosities is taught to avoid anything that impedes venous return, such as wearing garters and tight girdles, crossing the legs at the knees, and prolonged sitting. After the legs have been elevated for 10 to 15 min, support hose are applied. The patient should not sit in a chair for longer than 1 hr at a time. Walking is encouraged for at least 5 min every hour. The patient should elevate the legs whenever possible, but no less than twice a day for 30 min each time, and should avoid prolonged standing. Exercise, esp. walking, is encouraged to promote the muscular contraction that moves blood through the veins and minimizes venous stasis. Signs of thrombophlebitis, a complication of varicose veins, include heat and local pain. If surgery is performed, elastic stockings or antithrombus devices are applied postoperatively, and the foot of the bed is elevated above the level of the heart. Analgesics are prescribed and administered as needed. Circulatory assessment (color and temperature of toes, pedal pulses) is carried out according to protocol or the surgeon’s orders. The patient is watched for complications such as bleeding, infection, and neurosensory problems. Overweight patients must lose weight.