Varicose veins are large, dilated, tortuous, elongated superficial veins exhibiting reflux or retrograde flow as a result of valvular incompetence, weakness of the venous walls, or increased intraluminal pressure. They occur in 10-20% of the population, most commonly in the greater and lesser saphenous veins and their tributaries in the legs. Varicose veins may appear at any age, but the peak incidence is between 50 and 60 years of age. Varicose veins must be distinguished from spider veins or telangiectases, which are tiny, dilated, superficial veins visible on the skin surface.
Primary varicose veins result from intrinsic weakness in the walls of the veins coupled with incompetent, perforating veins; 50% of these cases are familial (genetic). Secondary varicose veins are most often caused by post-thrombotic deep venous insufficiency and the resulting diversion of flow into superficial collateral vessels.
They may also arise from superficial thrombosis. Less often, they are caused by arteriovenous fistulas. Both primary and secondary varicose veins develop progressively. Once a vein segment dilates, valvular incompetence develops and blood refluxes distally. This increases hydrostatic pressure distally, causing further vein dilation and elongation. Eventuall
y this process may propagate throughout the length of the vein and into peripheral branches and perforating veins. Varicose veins may account for 25% of venous ulcers.

Aetiology/ Risk factors
• Primary varicose veins
• Family history of varicose veins
• Female gender (three times more common in women)
• Pregnancy
• Occupations requiring prolonged standing
• Obesity
• Proximal obstructing lesions (e.g., tumour)
• Conditions predisposing to deep venous thrombosis—such as trauma, surgery, immobilisation, thrombophilia.

Signs and Symptoms:
Primary varicose veins are often asymptomatic, causing only cosmetic concerns. Secondary varicose veins are more likely to be accompanied by signs and symptoms, including the following:
• Chronic pain or heaviness/aching in the legs, often worse at night, and relieved by elevation
• Ankle oedema
• Skin ulcerations
• Superficial thrombosis
• Rupture with bleeding after minor trauma
• A brownish-blue shiny skin discoloration around the veins
• Skin over the vein may become dry, itchy and thin, leading to venous eczema
• The skin may darken because of the waste products building up in the legs
• Minor injuries to the area may bleed more than normal and/or take a long time to heal
• Rarely, there is a large amount of bleeding from a ruptured vein
• In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.