Case Presentation 1: A 38-year-old woman presented 6 months postpartum from the birth of her third child with pruritic bluish veins and a burning sensation behind her knees. She was embarrassed to wear skirts and dresses. On physical examination, she was obese and had prominent reticular veins behind her knees and along her lateral lower thighs (Figure 1).
Case Presentation 2: A 58-year-old woman presented with several years of painful bulging leg veins. An intensive care nurse, she noted heaviness and an aching pain that was worst at the end of her shift. On physical examination, she has large rope-like varicose veins along the right lower leg and left thigh (Figure 2).
Varicose veins are part of the spectrum of chronic venous disease and include spider telangiectasias, reticular veins, and true varicosities. Approximately 23% of US adults have varicose veins.1 If spider telangiectasias and reticular veins are also considered, the prevalence increases to 80% of men and 85% of women.2 Generally more common in women and older adults, varicose veins affect 22 million women and 11 million men between the ages of 40 to 80 years.1 Of these, 2 million men and women will develop symptoms and signs of chronic venous insufficiency, including venous ulceration.
The sheer prevalence of varicose veins and the substantial cost of treating late complications such as chronic venous ulcers contribute to a high burden on health care resources.2 Chronic venous ulcerations result in the loss of 2 million workdays and cost an estimated $3 billion per year to treat in the United States.3 Even varicose veins alone, without more advanced signs of chronic venous insufficiency, result in important …