Primary varicose veins can result from congenital weakness of the valves or venous wall; from conditions that produce prolonged venous stasis, such as pregnancy or wearing tight clothing; or from occupations that necessitate standing for an extended period.

Secondary varicose veins result from disorders of the venous system, such as
deep vein thrombophlebitis, trauma, and occlusion.

Long-standing varicose veins produce venous insufficiency and venous stasis ulcers, particularly around the ankles.

The patient with varicose veins may be asymptomatic or complain of mild to severe leg symptoms, including a feeling of heaviness that worsens in the evening and in warm weather; cramps at night; diffuse, dull aching after prolonged standing or walking; aching during menses; and fatigue. Exercise may relieve symptoms because venous return improves.

Inspection of the affected leg reveals dilated, purplish, ropelike veins, particularly in the calf. Deep vein incompetence causes orthostatic edema and stasis of the calves and ankles. Palpation may reveal nodules along affected veins and valve incompetence, which can be checked by the manual compression test and Trendelenburg’s test.

To do the manual compression test, palpate the dilated vein with the fingertips of one hand. With the other hand, firmly compress the vein at a point at least 8″(20.3 cm) higher. Feel for an impulse transmitted to your lower hand. With competent saphenous valves, you won’t detect any impulse. A palpable impulse indicates incompetent valves in a vein segment between your hands.

To do Trendelenburg’s test (retrograde filling test), mark the distended veins with a pen while the patient stands. Then have her lie on the examination table and elevate her leg for about a minute to drain the veins. Next, have her stand while you measure venous filling time. Competent valves take at least 30 seconds to fill. If the veins fill in less than 30 seconds, have the patient lie on the examination table again, and elevate her leg for 1 minute. Then apply a tourniquet around her upper thigh. Next, have her stand. If leg veins still fill in less than 30 seconds, suspect incompetent perforating vein and deep vein valves (functioning valves block retrograde flow).

Next, remove the tourniquet. If the veins fill again in less than 30 seconds, suspect incompetent superficial vein valves that allow backward blood flow.