Which clinical history findings are characteristic of varicose veins and spider veins (telangiectasia)?

Updated: Sep 25, 2020
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Patients with varicose veins may present with acute varicose complications, including variceal bleeding, new onset of dermatitis, thrombophlebitis, cellulitis, and ulceration. Patients may also consult a physician because of worsening chronic symptoms or for a variety of other reasons. Some are seeking advice on the medical implications of varicose veins. Others have purely aesthetic concerns.

A careful history exposes the patient's underlying concerns and guides further workup and treatment planning. Treatment that does not properly address the patient's primary concerns cannot result in a satisfactory overall outcome.

Patients who have become acclimatized to their chronic disease may not volunteer information about symptoms. Common symptoms that should be elicited include leg heaviness, exercise intolerance, pain or tenderness along the course of a vein, pruritus, burning sensations, restless legs, night cramps, edema, skin changes, and paresthesias.

Subjective symptoms usually are more severe early in the progression of disease, less severe in the middle phases, and worse again with advancing age. Symptoms do not correlate with the size or extent of visible varices or with the volume of reflux.

Not all symptomatic patients are aware of their symptoms because the onset may be extremely gradual. After treatment, patients are often surprised to realize how much chronic discomfort they had accepted as normal.

Common symptoms of telangiectasia include burning, swelling, throbbing, cramping, and leg fatigue. Pain associated with larger varicose veins usually is a dull ache that is worse after prolonged standing.

Pain caused by venous insufficiency is often improved by walking or by elevating the legs in contrast to the pain of arterial insufficiency, which is worse with ambulation and elevation.

Pain and other symptoms may worsen with the menstrual cycle, with pregnancy, and in response to exogenous hormonal therapy (eg, oral contraceptives). A small number of women regularly experience pain associated with their varicose veins after sexual intercourse.

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