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Am Fam Physician. 1999;59(9):2596-2598

Approximately 15 percent of men and 25 percent of women have visible varicose veins. Symptoms attributed to varicose veins include heaviness, swelling, aching, cramping and itching of the legs. Although the removal of varicose veins costs millions of dollars annually, little objective evidence validates the assumption that surgical therapies ameliorate these symptoms. Bradbury and colleagues used a community study in a city in Scotland to correlate factors such as age, sex and lower limb symptoms with the presence and severity of varicose veins.

They worked with general practitioners to study a representative sample of adults aged 18 to 64 years. The 1,566 study participants attended a special evening clinic or were visited at home by study personnel. Each participant completed an extensive questionnaire concerning the presence of symptoms. Participants were examined using standardized protocols and methods of recording varicosities and related findings. The mean age of the 867 women included in the study was 44.8 years, compared with a mean age of 45.8 years for the 699 men in the study.

Women were more likely than men to report symptoms, but for both sexes the prevalence of symptoms was strongly related to age. The age-adjusted prevalence of trunk varices was higher in men (39.7 percent) than in women (32.2 percent). The most common symptom reported in women was aching (53.8 percent); in men, the most common symptom was cramping (34.0 percent). No differences in symptoms were found between the right and left legs in any of the variables measured. The presence and severity of varices in men was statistically significant only with the symptom of itching. In women, statistically significant correlations were found between the severity of varices and the symptoms of heaviness, aching and itching. Clinically, the level of agreement between these symptoms and the severity of varices was too low to be useful in determining management. For example, in spite of statistically significant correlation, aching was reported by 45 percent of women without evidence of varices and by 63 percent of those with grade 2 or 3 varices.

The authors conclude that the presence of symptoms alone cannot be used to reliably select patients for surgical treatment of varicosities. Lower limb symptoms are very prevalent in adults, irrespective of the presence of varices, and may not be improved by surgery.

editor's note: It is good to see research being conducted on common but unglamorous conditions such as varicose veins; however, the findings from this study raise several issues. The study finds that very large numbers of adults, especially women, have non-specific leg symptoms about which we understand little and for which we have no therapies based on pathophysiology or clinical trials. This study confirms that some patients have extensive and severe varicosities yet remain asymptomatic; it also throws doubt on the etiology of symptoms commonly attributed to varicosities. The conclusion from this very large and well-conducted study is that surgery for varicose veins may have cosmetic benefits but little or no effect on symptoms. Many health maintenance organizations require well-documented symptoms attributed to varicose veins in addition to poor results from nonsurgical treatments before covering the costs of surgery or sclerosing therapy. Will the results of this study lead to the re-classification of all varicose vein surgery into the “cosmetic” group?—a.d.w.

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