Dr. Stephen Black

17/06/2025

Physiological and Clinical Differences Between Normal Legs and Varicose Veins
In healthy lower limbs, venous return from the legs to the heart is facilitated by a complex system of deep and superficial veins, aided by functioning venous valves and the contraction of surrounding muscles. The veins in normal legs are typically not visible or may appear as faint lines beneath the skin, reflecting efficient hemodynamics and valve integrity. There is no blood pooling, and symptoms such as heaviness, discomfort, or swelling are absent under normal conditions.
Varicose veins, however, are a manifestation of chronic venous insufficiency (CVI), in which the vein walls or valves become weakened or incompetent. This leads to venous reflux, a condition where blood flows backward and accumulates in the superficial veins, causing them to dilate, elongate, and become tortuous. Clinically, these veins appear visibly enlarged, often bluish or purplish, and may protrude from the skin surface. Common accompanying symptoms include leg fatigue, throbbing pain, swelling (especially around the ankles), itching, and skin discoloration, with progression in severe cases to venous eczema or ulceration.
While normal legs exhibit efficient circulatory dynamics and vascular integrity, legs affected by varicose veins demonstrate structural and functional deterioration of the venous system. Early recognition and appropriate treatment—ranging from compression therapy to minimally invasive surgical interventions—are essential in preventing long-term complications.

17/06/2025

17/06/2025

Management and Treatment of Varicose Veins: A Contemporary Dermatological Perspective
Varicose veins, characterized by dilated, tortuous superficial veins, are a common manifestation of chronic venous insufficiency (CVI) and affect a significant portion of the adult population, particularly women and older individuals. While often dismissed as a cosmetic issue, varicose veins can lead to progressive symptoms such as heaviness, aching, edema, skin changes, and in advanced cases, venous ulcers. The pathophysiology involves valve incompetence, venous reflux, and increased hydrostatic pressure in the lower extremities.
Dermatologists and phlebologists have increasingly emphasized early diagnosis and multidisciplinary management to prevent complications. Conservative measures, including leg elevation, exercise, weight management, and compression therapy, remain first-line interventions, particularly for early-stage disease. However, advances in minimally invasive procedures have revolutionized varicose vein treatment over the past two decades.
Sclerotherapy, in which a sclerosing agent is injected into affected veins, remains a mainstay for treating reticular and spider veins. For larger varicosities and saphenous vein insufficiency, endovenous thermal ablation—via laser (EVLA) or radiofrequency (RFA)—has largely replaced surgical stripping due to its efficacy, safety profile, and shorter recovery times. In selected patients, adjunctive procedures such as ambulatory phlebectomy and foam sclerotherapy may also be used.
Patient selection, duplex ultrasound mapping, and a tailored approach based on disease severity, symptom burden, and anatomical considerations are essential for optimal outcomes. With increasing public awareness and technological advances, the focus of contemporary vein care has shifted from symptom relief alone to long-term venous health, skin preservation, and quality of life improvement.