• Ahsan Manzoor Bhatti
  • Khalid Siddique
  • Riaz Anwar Bashir
  • Muhammad Tanveer Sajid
  • QuratulAin Mustafa
  • Sye Mukarram Hussain
  • Irfan Shukr
  • Muhammad Ahmed


Background: Varicose veins are among the most common ailments of the affluent nations. Primarily it is considered to be caused by valvular dysfunctions, but it may be secondary to other pathologies. This study was conducted to evaluate the unusual secondary causes of varicose veins. Methods: This case-series was conducted at department of vascular surgery Combined Military Hospital Rawalpindi from January 2009 to January 2012 over a period of twoyears. All cases of varicose veins reporting to vascular surgical department CMH Rawalpindi were studied over a period of 02years. Detailed history and thorough physical examination was performed in all cases. Cases secondary to deep vein thrombosis (DVT) of limb up to common femoral vein (CFV) and pelvic malignancy were excluded. Duplex Ultrasonography (USG) was performed in all cases while CT angiography/Venography was conducted in those suspected of having secondary cause.Results: A total of 288 cases were found eligible and included in the study. Ten patients (3.47%) were having unusual secondary cause most common being traumatic arterio-venous fistula (AVF) (60% cases) followed by iliac vein thrombosis (20%). One patient had Klippel Trenaunay syndrome (KTS) and another suffered arterio-venous malformations (AVM). Conclusion: An unusual secondary varicose vein is important but rare clinical entity. Diagnosis is often delayed/overlooked and patients are mismanaged for extended period of time. Exact delineation of aetiology, prompt recognition and appropriate operative technique significantly alters outcome.Keywords: Secondary varicose veins, AVF, KTS, duplex ultrasound


Korn P, Patel ST, Heller JA, Deitch JS, Krishnasastry KV, Bush HL, et al. Why insurers should reimburse for compression stockings in patientswith chronic venous stasis. J Vasc Surg 2002;35:950–7.

Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. Qualityof life in patients with chronic venous disease: San Diego populationstudy. J Vasc Surg 2003;37:1047–53.

Rabe E, Pannier F. Epidemiology of chronic venous disorders. In: Gloviczki P, editor. Handbook of venous disorders: guidelines of theAmerican Venous Forum. 3rd ed. London: Hodder Arnold, 2009; p.105–10.

Golledge J, Quigley FG. Pathogenesis of varicoseveins. Eur J Vasc Endovasc Surg 2003;25:319–24.

Sadick NS. Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascularlaser, and radiofrequency closure. Dermatol Clin 2005;23(3):443–55.

Jones RH, Carek PJ. Management of Varicose Veins. Am Fam Physician 2008;78(11):1289–94.

Bradbury A, Ruckley CV. Clinical presentation and assessment of patients with venous disease. In: Gloviczki P, editor. Handbook ofvenous disorders: guidelines of the American Venous Forum. 3rd ed. London: Hodder Arnold 2009; p. 331–41.

Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P, American Venous Forum et al. Updated terminology of chronic venous disorders: the VEIN-TERMtransatlantic interdisciplinary consensus document. J Vasc Surg 2009;49:498–501.

Gloviczki P, Comerota AJ, Dalsing MC, Eklof GB, Gillespie DL, Gloviczki ML, et al. The care of patients with varicose veins andassociated chronic venous diseases: Clinicalpractice guidelines of the Society for VascularSurgery and the American Venous Forum. J Vasc Surg 2011;53:2S–48S.

Vasquez MA, Rabe E, McLafferty RB, Shortell CK, Marston WA, Gillespie D, et al. Revision of the venous clinical severity score: venousoutcomes consensus statement: Special communication of the AmericanVenous Forum Ad Hoc Outcomes Working Group. J Vasc Surg 2010;52:1387–96.

Abai B, Labropoulos N. Duplex ultrasound scanning for chronicvenous obstruction and valvular incompetence. In: Gloviczki P, editor. Handbook of venous disorders: guidelines of the American VenousForum. 3rd ed. London: Hodder Arnold, 2009;p. 142–55.

Park UJ, Yun WS, Lee KB, Rho YN, Kim YW, Joh JH, et al. Analysisof the postoperative hemodynamic changes in varicose vein surgeryusing air plethysmography. J Vasc Surg 2010;51:634–8.

Amsler F, Willenberg T, Blättler W. In search of optimal compressiontherapy for venous leg ulcers: a meta-analysis of studies comparingdiverse [corrected] bandages with specifically designed stockings. J Vasc Surg 2009;50:668–74.

Palfreyman SJ, Michaels JA. A systematic review of compression hosieryfor uncomplicated varicose veins. Phlebology 2009;24(suppl1):13–33.

Pittaluga P, Chastanet S, Locret T, Rousset O. Retrospective evaluationof the need of a redo surgery at the groin for the surgical treatmentof varicose vein. J Vasc Surg 2010;51:1442–50.

O’Hare JL, Stephens J, Parkin D, Earnshaw JJ. Randomized clinicaltrial of different bandage regimens after foam sclerotherapy for varicoseveins. Br J Surg 2010;97:650–6.

Perrin M. Endovenous radiofrequency ablation of saphenous veinreflux. The VNUS Closure procedure with Closurefast. An updatedreview. Int Angiol 2010;29:303–7.

Christenson JT, Gueddi S, Gemayel G, Bounameaux H. Prospective randomized trial comparing endovenous laser ablation and surgery fortreatment of primary great saphenous varicose veins with a 2-yearfollow-up. J Vasc Surg 2010;52:1234–41.

Coleridge-Smith PD. Leg ulcer treatment. J Vasc Surg 2009;49:804–8.

Rasmussen LH, Bjoern L, Lawaetz M, Lawaetz B, Blemings A, EklofB. Randomized clinical trial comparing endovenous laser ablationwith stripping of the great saphenous vein: clinical outcome andrecurrence after 2 years. Eur J Vasc Endovasc Surg 2010;39:630–5.

Ha JF, Sieunarine K. Arteriovenousfistula secondary to recurrent metacarpophalangeal joint dislocation: A Case Report. Ochsner J 2009;9:14–6.

Huang W, Villavicencio JL, Rich NM. Delayed treatment and late complications of atraumatic arteriovenous fistula. J Vasc Surg 2005;41:715–7.