The pathological changes are confined to the superficial veins of the lower limbs, where valvular insufficiency and weakened venous walls impair blood return, leading to venous elongation, tortuosity, and dilation. This condition most commonly occurs in the great saphenous vein, with a minority of cases involving the small saphenous vein either in combination or in isolation.

bubble_chart Clinical Manifestations

1. It is commonly seen in manual laborers who stand for long periods. After prolonged standing, the affected limb may feel heavy, sore, numb, and fatigued.
2. In the standing position, the great saphenous vein and/or small saphenous vein may appear raised, dilated, tortuous, or coiled into clusters, which disappear when lying down. The lower part of the calf may exhibit pigmentation, desquamation, eczema, and chronic ulcers.

bubble_chart Diagnosis

1. It is commonly seen in manual laborers who engage in prolonged standing. After prolonged standing, the affected limb may feel heavy, sore, numb, and fatigued.
2. In the standing position, the great saphenous vein and/or small saphenous vein may appear raised, dilated, tortuous, or coiled into clusters, which disappear when lying down. The lower leg may exhibit pigmentation, desquamation, eczema, and chronic ulcers.
3. Lower limb venous function examination
   1. Test for the function of the great saphenous vein valve membrane and the communicating branch valve membrane between the great saphenous vein and deep veins. The patient lies supine with the affected limb elevated, and a tourniquet is applied to the upper third of the thigh. After standing, if the veins below the tourniquet rapidly fill within 30 seconds without releasing the tourniquet, it indicates incompetence of the communicating branch vein valve membrane below the tourniquet. If the veins rapidly fill from top to bottom after releasing the tourniquet, it indicates incompetence of the great saphenous vein valve membrane.
   2. Test for the function of the small saphenous vein valve membrane and the communicating branch valve membrane between the small saphenous vein and deep veins. The results and implications are similar to the above test.
   3. Localization test for incompetent communicating branch valve membranes. The patient lies supine with the affected limb elevated, and a tourniquet is applied at the root of the thigh. First, an elastic bandage is wrapped from the toes upward to the popliteal fossa, and then a second elastic bandage is wrapped downward from the tourniquet. The patient stands while the first elastic bandage is unwrapped downward and the second elastic bandage is continuously wrapped downward. If varicose veins appear in the gap between the two bandages, it indicates the presence of a communicating branch vein with incompetent valve membranes at that location.
   4. Deep vein patency test. If the varicose veins worsen, it indicates deep vein obstruction; if they lessen or disappear, it indicates deep vein patency.
4. It should be differentiated from secondary varicose veins caused by primary lower limb deep vein valve membrane incompetence, post-thrombotic syndrome, and congenital venous malformation with bone hypertrophy syndrome. The latter is characterized by hemangioma (nevus) and limb lengthening and thickening. Venography may be performed if necessary. Simple lower limb varicose veins show incompetence and dilation of the superficial vein valve membranes, with normal deep veins.

bubble_chart Treatment Measures

1. Elastic stockings or elastic bandage compression: Suitable for those during pregnancy, with mild conditions, advanced age, or poor overall condition who cannot tolerate surgery.
2. Sclerosing agent injection: Used for the treatment of residual varicose veins after surgery. Commonly used sclerosing agents include 5% sodium morrhuate, phenol glycerin solution, 50% glucose, and 20-30% sodium chloride solution.
3. Surgical treatment: All symptomatic patients, as long as there are no contraindications, should undergo surgery, involving high ligation of the great saphenous vein and/or small saphenous vein, stripping of the main trunk, removal of dilated tributaries, and ligation of incompetent perforating veins.