In Klippel-Trenaunay syndrome, congenital arteriovenous fistulas, diffuse cutaneous capillary angiomas, and varicose veins occur in the legs. The increased flow in the veins aggravates varicosities but may not cause them. Secondary factors include hormonal changes during early pregnancy, pressure on the pelvic veins during later pregnancy, and an abdominal tumor. Previous deep thrombophlebitis, with vein recanalization resulting in deep valve incompetency, may lead to secondary incompetency of the perforator veins, and varicose veins may develop. Symptoms and Signs Varicose veins may be associated with aching, fatigue, or heat that is relieved by elevating the leg or by wearing compression hosiery.
Symptoms tend to worsen during menstruation.
Initially, varicosed superficial veins may be tense and palpable but not necessarily visible. They may later enlarge and protrude and become visibly obvious to the patient. Diagnosis Varicose veins are usually diagnosed by the patient, but their extent is usually greater than can be determined by simple inspection and is judged accurately only by palpation with the patient standing. Osteoarthritis of the hip or knee or internal derangements of the knee must be excluded. If pulses are present or the foot is warm, an alternate diagnosis for the rest pain must be considered.