Leg vein varicosities can present in several ways such as:

1. ugly looking flat or bulging veins

2. leg swelling

3. lower leg hyperpigmentations

4. lipodermatosclerosis/ skin thickening

5. venous status ulcers

Progressive leg ache, heaviness or even pain that worsens during the day and improves after leg rest commonly occur among those with leg varicosities. Some patient may even develop nocturnal cramping.

Risk factors in developing varicose veins include:

• hereditary or family history

• female gender

• on oral contraceptives

• pregnancy

• age, higher in elderly

• overweight/ obese

• work that require prolong standing as in nurses, security guards, receptionist and others

• history of trauma

Patient with signs and symptoms of varicose vein may have chronic venous reflux. Normally, leg venous blood flow moves towards the heart in one direction. Chronic venous insufficiency or venous reflux occurs in the presence of dysfunctional venous valve along the leg veins leading to a bidirectional blood flow. Presence of chronic venous insufficiency lead to increase venous pressure. This increase in venous pressure causes the veins to dilated enlarge vein and leg swelling and also explain the leg symptoms of the patient such as intermittent leg ache and heaviness. This can be confirmed by performing a venous duplex ultrasound or a venous phlethysmography

Leg varicosities remain a benign health condition and could be initially managed conservatively with:

1. leg rest through intermittent leg elevations during the day.

2. medical grade class II or III compression stockings

3. regular exercise

4. life style modification

5. weight loss

Medications maybe prescribed depending on the overall condition of the patient

There are several venous procedures available to treat leg varicosities. Treatment options depend on the severity of the venous disease and the presence of venous reflux.

Patients with leg varicosities in the form of reticular, spider or bulging veins in the absence of sign and symptoms of lower extremity venous reflux may undergo office based, out patient procedure such as Sclerotherapy, and/or Stab Microphlebectomy.

Patients with signs and symptoms of venous reflux, confirmed with Venous Duplex Scan may undergo venous anti reflux procedure. Most venous procedures, except for vein stripping maybe done as an out patient procedure. Treatment options include:

1. Endovenous Laser Therapy (EVLT)

2. Radiofrequency Ablation Therapy (RFA)- Closurefast

3. Mechanical Chemical Ablation ( MCA)- Clarivein

4. Venaseal

5. Vein stripping

Treatment of leg varicosities may entail utilization of a combination of the different venous procedures depending on the severity of the venous disease.