Varicose veins are common presentation in primary care, but knowing who to reassure, who to investigate and who to refer isn't always straightforward. Today we are doing something different- we are going work through five real-world quick-fire cases to highlight practical assessment and management of VV’s. I am joined by Dr Sam Dunn.
Practical clinical pearls:
1. Pregnancy- Treat the symptoms, not the veins.
Compression, movement, avoiding prolonged standing and leg elevation are usually all that’s needed. Reassess 3–6 months postpartum.
2. Examine varicose veins standing up.
They can disappear when the patient lies down. Look for oedema, pigmentation, eczema, lipodermatosclerosis and ulcers—and check the pulses before compression.
3. Compression isn’t automatically benign.
Check arterial circulation first. If pulses are reduced or arterial disease is possible, assess further before prescribing higher-grade compression.
4. Know who needs referral.
Symptoms, oedema, skin changes, ulcers, thrombophlebitis or bleeding mean this is more than a cosmetic problem and warrants referral.
5. A bleeding varicose vein is an emergency waiting to happen.
Lie down, elevate the leg and apply firm pressure. If it doesn’t stop—or starts again—seek urgent medical care. Even when it stops, arrange urgent referral.
Bio:
Dr Sam Dunn. Sam is Medical Director at Palm Clinic and an experienced cosmetic medicine and vein physician. After beginning his career in emergency medicine, Sam has spent almost two decades practising phlebology and cosmetic medicine. He holds Diplomas in Procedural Phlebology, Skin Cancer Medicine and Community Emergency Medicine, and is a Fellow of the New Zealand Society of Cosmetic Medicine.
Resources:
https://www.palmclinic.co.nz/vein-care/what-to-expect
https://www.anzsvs.org.au/patient-information/varicose-veins/
https://medlineplus.gov/varicoseveins.html
