varicose vein

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.

nursing 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.

Varicose veins

var·i·cose vein

(var'i-kōs vān)

Permanent dilation and tortuosity of a vein, most commonly seen in the legs, probably as a result of congenitally incomplete valves; there is a predisposition to varicose veins among persons in occupations requiring long periods of standing, and in pregnant women.

VARICOSE VEINS IN LEG

varicose vein

A dilated vein. This condition may occur in almost any part of the body but is most common in the lower extremities and in the esophagus.

Etiology

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.

Symptoms

Most varicose veins of the legs are asymptomatic, although they may be cosmetically undesirable. Esophageal varices and hemorrhoidal varices may bleed profusely. See: illustration

Treatment

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.

Patient care

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.

See also: vein