alcohol consumption due to the vasodilatation side effect in relation to gravity and blood viscosity. Diagnosis Clinical test Clinical tests that may be used include: Trendelenburg test–to determine the site of venous reflux and the nature of the saphenofemoral junction Investigations Traditionally, varicose veins were investigated using imaging techniques only if there was a suspicion of deep venous insufficiency, if they were recurrent, or if they involved the saphenopopliteal junction. This practice is now less widely accepted. People with varicose veins should now be investigated using lower limbs venous ultrasonography. The results from a randomised controlled trial on patients with and without routine ultrasound have shown a significant difference in recurrence rate and reoperation rate at 2 and 7 years of follow-up. Stages The CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) Classification, developed in 1994 by an international ad hoc committee of the American Venous Forum, outlines these stages C0 – no visible or palpable signs of venous disease C1 – telangectasia or reticular veins C2 – varicose veins C2r - recurrent varicose veins C3 – edema C4- changes in skin and subcutaneous tissue due to Chronic Venous Disease C4a – pigmentation or eczema C4b – lipodermatosclerosis or atrophie blanche C4c- Corona phlebectatica C5 – healed venous ulcer C6 – active venous ulcer C6r- recurrent active ulcer Each clinical class is further characterized by a subscript depending upon whether the patient is symptomatic (S) or asymptomatic (A), e.g. C2S. Treatment Treatment can be either active or conservative. Active Treatment options include surgery, laser and radiofrequency ablation, and ultrasound-guided foam sclerotherapy. Newer treatments include cyanoacrylate glue, mechanochemical ablation, and endovenous steam ablation. No real difference could be found between the treatments, except that radiofrequency ablation could have a better long-term benefit. Conservative The National Institute for Health and Clinical Excellence (NICE) produced clinical guidelines in July 2013 recommending that all people with symptomatic varicose veins (C2S) and worse should be referred to a vascular service for treatment. Conservative treatments such as support stockings should not be used unless treatment was not possible. The symptoms of varicose veins can be controlled to an extent with the following: Elevating the legs often provides temporary symptomatic relief. Advice about regular exercise sounds sensible but is not supported by any evidence. The wearing of graduated compression stockings with variable pressure gradients (Class II or III) has been shown to correct the swelling, nutritional exchange, and improve