Varicose veins are dilated, elongated, and tortuous vessels which have incompetent valves and most commonly involve the saphenous system. They may be limited to the superficial veins (primary) or be secondary to obstruction and valvular incompetence of the deep venous system (secondary). The resulting venous stasis may lead to the development of phleboliths, calcified thrombi within a vein that appear as rounded densities and often contain lucent centers. Phleboliths are also commonly seen inpelvic veins and in the dilated venous spaces of a cavernous hemangioma. Chronic venous stasis may also lead to periosteal new bone formation along the tibial and fibular shafts as well as the development of plaquelike calcification in the chronically congested subcutaneous tissues.
Although the diagnosis of varicose veins is primarily a clinical observation, venography is of value in demonstrating the competency of perforating veins and the patency of the deep venous system, especially if surgical intervention is considered. Following the application of a tourniquet to occlude superficial flow, the peripheral injection of contrast material opacifies the deep venous system. Following exercise, filling of the superficial veins indicates the presence of incompetent perforating veins above the level of the tourniquet. Contrast material can also be injected directly into a varicosity (varicography). This method is of special value for visualizing incompetent midthigh and gastrocnemius perforating veins, as well as investigating patients with recurrent varicose veins.gastrocnemius vein · calcified varicose veins ·