This suggests that varicose veins are a dynamic response to venous hypertension and are not thin walled structures as previously thought.

Placing a senior emergency physician with the triage nurse reduced waiting times for walk-in cases. One third of attendances were treated and discharged quickly, allowing the consulting room and PACS 1/PACS 2 doctors to act more efficiently.

Objective: Determination of the ratio of collagen and elastin to protein content of varicose/non-varicose veins from calf and determination of collagen, elastin and smooth muscle density of varicose/non-varicose vein walls. Design: Prospective study; control vein samples obtained from amputees for ischaemic vascular disease and varicose vein samples obtained from an equivalent Position following surgical stripping. Setting: Departments of Human Morphology and Vascular Surgery, Queen's Medical Centre, University of Nottingham, UK. Patients: Seven patients with no evidence of venous disease treated by amputation of the lower limb for vascular disease and 12 patients treated for varicose veins by ligation and stripping of the long saphenous vein. Interventions: Vein sections were examined biochemically and histologically using stereological techniques. Main outcome measures: Biochemical quanitfication of collagen, elastin and protein and stereological analysis of collagen, elastin and smooth muscle density of varicose and non-varicose veins. Results: There was no difference between the collagen/Protein or elastin/protein ratio in varicose and normal veins but there was a significant increase in muscle density with corresponding decrease in collagen and elastin density in the walls of varicose veins compared with non-varicose vein controls. Conclusions: There were no differences in the collagen or elastin content of varicose veins when compared with non-varicose veins. Smooth muscle hypertrophy occurs in varicose veins, which appears to disrupt the collagen/elastin lattice of the vein wall.

Objectives: To assess the ability of compression stockings to reduce the postoperative recurrence of varicose veins after surgery and to assess patient compliance. Design: Prospective randomized trial with follow-up to 1 year after surgery. Patients: Sixty-nine patients presenting for varicose vein surgery. Interventions: Interview for stocking compliance postoperatively with clinical and Doppler assessment of recurrence at 3, 6, 9 and 12 months postoperatively. Main outcome measures: Recurrence of varicosities and patient compliance. Results: 39% of patients allocated stockings were either lost to follow-up or abandoned their use after 3 months; 11% declined the stockings on presentation. By 1 year postoperatively, only 6% in the stocking group had recurrent varicose veins compared with 71% in the control group (no stockings). Conclusion: Despite an early, relatively high noncompliance rate, external compression hosiery significantly reduced postoperative recurrence of varicose veins.