Varicose veins

What you should cover Varicose veins are very common: 40% of men and 32% of women aged 18-64 years have this condition. 1 Common presenting complaints are "heavy legs", swelling, restless legs, cramps, itching, and tingling, 2 but these symptoms are often unrelated to the presence of varicose veins. 2 Document risk factors such as increasing age, family history, obesity, and occupational history associated with prolonged standing. 3 Varicose veins may first become apparent during pregnancy and the risk increases with parity. 1 3 Ask about red flag symptoms such as weight loss and rectal bleeding where varicose veins may be due to a pelvic or abdominal mass. Checklist: what to include in referral letter to vascular surgeon Background information-symptoms, duration, risk factors including occupation, thromboembolic disease, other relevant medical history Any treatment received so far and outcome (for example, trial of support hosiery, previous surgery) Details of any complications Most recent examination findings, how findings have evolved over time Patient's concerns and expectations Useful resources For patients PatientUK ( www.patient.co.uk/health/Varicose-Veins.htm ) NHS Choices ( www.nhs.uk/conditions/varicose-veins/Pages/Whatarevaricoseveins.aspx ) Circulation Foundation ( www.circulationfoundation.org.uk/vascular_disease/varicose_veins ) For healthcare professionals Tisi P. Varicose veins. Clinical Evidence 2007;10:212 ( http://clinicalevidence.bmj.com/ceweb/conditions/cvd/0212/0212-2007-10.pdf ) Medscape: Pathogenesis of varicose veins and implications for clinical management ( www.medscape.com/viewarticle/567029 ) NHS Clinical Knowledge Summaries ( www.cks.nhs.uk/varicose_veins#-341100 ) We thank Dr Emma Holland (GP trainee) and the general practitioners at School Lane Surgery in Thetford for advice and guidance during the preparation of the manuscript.