Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Varicocele Varicose Veins 1517

differential diagnosis

n/a

management

n/a

specific therapy

■indicated if associated testis shrinkage, pain, infertility

■occlusion of spermatic veins by surgery or interventional radiology

follow-up

n/a

complications and prognosis

n/a

VARICOSE VEINS

RAJABRATA SARKAR, MD

history & physical

History

■Seen in 10–20% of adult population

■Familial component in 50% of patients

■May develop during pregnancy

■May be asymptomatic, or cause:

➣Aching pain

➣Early fatigue

➣Superficial thrombophlebitis

➣bleeding

Signs & Symptoms

■May range from telangiectasia (“venous spider”) to protuberant vein

■Check for associated deep venous insufficiency

➣Pt may have history of prior DVT

➣Duplex scan if there are symptoms of leg swelling

■Trendelenberg test for superficial insufficiency:

➣Tourniquet at thigh with pt supine

➣Have pt stand – if varicosity still dilates then there is reflux from

deep to superficial system

tests

■Duplex scan for deep venous insufficiency in selected pts