Chronic venous disease, reviewed herein, is manifested by a spectrum of signs and symptoms, including cosmetic spider veins, asymptomatic varicosities, large painful varicose veins, edema, hyperpigmentation and lipodermatosclerosis of skin, and ulceration. However, there is no definitive stepwise progression from spider veins to ulcers and, in fact, severe skin complications of varicose veins, even when extensive, are not guaranteed. Treatment options range from conservative (eg, medications, compression stockings, lifestyle changes) to minimally invasive (eg, sclerotherapy or endoluminal ablation), invasive (surgical techniques), and hybrid (combination of ≥1 therapies). Ms L, a 68-year-old woman with varicose veins, is presented. She has had vein problems over the course of her life. Her varicose veins recurred after initial treatment, and she is now seeking guidance regarding her current treatment options.
The GSV, anterior accessory branch of the GSV, and the SSV are common sources of axial reflux (see Figure 2) in the lower extremity that can lead to the development of varicose veins and associated symptoms. These veins can be treated by ligation or stripping or by endovenous ablation.
Types of venous reflux include axial, perforator, and local reflux. Axial reflux is reversal of the normal direction of blood flow in the major vessels of either the deep or superficial venous system of the lower extremity, in which blood flow is directed from the inguinal or popliteal region down toward the foot. Axial reflux due to valvular incompetence may occur vertically along the length of the lower extremity in the great saphenous vein and its accessory branches and in the small saphenous vein. Perforator reflux occurs in horizontal tributaries that connect deep to superficial systems, and local reflux is isolated within short clusters of varicose veins.
Longitudinal color ultrasound and spectral tracing from 2 patients. A, Example of normal phasic flow in the right GSV at the SFJ. B, Example of reflux in the right GSV after manual augmentation—the application of gradual, firm pressure distal to the location of interest followed by swift release to prompt an increase in venous flow velocity.
Thank you for submitting a comment on this article. It will be reviewed by JAMA editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 12
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.