Do Primary Varicose Veins Lead to Ulceration?

Abstract

A decade ago the unequivocal answer to this question would have been 'no.' With better understanding of venous anatomy and flow patterns, the answer is now clearly 'yes.' Part of the response, of course, hinges upon accepted definitions of primary varicose veins. Superficial dilated veins, usually larger than 4 mm in diameter, are considered to be varicose. 1 Some authorities include tortuosity within this definition 2 -ie, saccular dilation of the veins which are also tortuous. Superficial and smaller blue colored reticular veins, not really varicose by the above definitions, can also contribute to ulceration. 1 Primary varicose veins are neither congenital (though this problem tends to be familial) nor are they secondary to deep venous pathology. The cause or causes of primary varicosities have yet to be identified. Venous ulceration traditionally (and incorrectly) had been linked to the post-phlebitic leg (a misnomer). Secondary varices are due to deep venous disease: proximal obstruction, valvular incompetence, or a combination of both. A better term for venous dysfunction is chronic venous insufficiency (CVI) which comprises a spectrum of pathophysiology. On the basis of clinical observations and surgical results 3 after superficial venous ablation we now know that lipodermatosclerosis (LDS) and ulceration can relate to superficial venous incompetence alone. The proportion of such cases varies in different series, but has been reported to range from 17% to as high as one-half of cases of venous ulceration. 4 Effective ablation of superficial incompetence leads to healing since limbs afflicted with this form of CVI have virtually normal deep venous circulation.