Phlebitis and thrombosis are common sequelae of varix, and may prove dangerous, either by spreading into the large venous trunks or by giving rise to emboli.  The larger the varix the greater is the tendency for a thrombus to spread upwards and to involve the deep veins.  Thrombi usually originate in venous cysts or pouches, and at acute bends on the vessel, especially when these are situated in the vicinity of the knee, and are subjected to repeated injuries—­for example in riding.  Phleboliths sometimes form in such pouches, and may be recognised in a radiogram.  In a certain proportion of cases, especially in elderly people, the occurrence of thrombosis leads to cure of the condition by the thrombus becoming organised and obliterating the vein.

Treatment.—­At best the treatment of varicose veins is only palliative, as it is obviously impossible to restore to the vessels their normal structure.  The patient must avoid wearing anything, such as a garter, which constricts the limb, and any obvious cause of direct pressure on the pelvic veins, such as a tumour, persistent constipation, or an ill-fitting truss, should be removed.  Cardiac, renal, or pulmonary causes of venous congestion must also be treated, and the functions of the liver regulated.  Severe forms of muscular exertion and prolonged standing or walking are to be avoided, and the patient may with benefit rest the limb in an elevated position for a few hours each day.  To support the distended vessels, a closely woven silk or worsted stocking, or a light and porous form of elastic bandage, applied as a puttee, should be worn.  These appliances should be put on before the patient leaves his bed in the morning, and should only be removed after he lies down at night.  In this way the vessels are never allowed to become dilated.  Elastic stockings, and bandages made entirely of india-rubber, are to be avoided.  In early and mild cases these measures are usually sufficient to relieve the patient’s discomfort.

Operative Treatment.—­In aggravated cases, when the patient is suffering pain, when his occupation is interfered with by repeated attacks of phlebitis, or when there are large pouches on the veins, operative treatment is called for.  The younger the patient the clearer is the indication to operate.  It may be necessary to operate to enable a patient to enter one of the public services, even although no symptoms are present.  The presence of an ulcer does not contra-indicate operation; the ulcer should be excised, and the raw surface covered with skin grafts, before dealing with the veins.

The operation of Trendelenburg is especially appropriate to cases in which the trunk of the great saphena vein in the thigh is alone involved.  It consists in exposing three or four inches of the vein in its upper part, applying a ligature at the upper and lower ends of the exposed portion, and, after tying all tributary branches, resecting this portion of the vein.