Symptoms of Great Saphenous Vein (GSV) Reflux
GSV reflux causes localized symptoms at the site of varicose veins including pain, burning, itching, and tingling, along with generalized leg symptoms of heaviness, cramping, throbbing, restlessness, and swelling that characteristically worsen at the end of the day after prolonged standing and improve with leg elevation. 1
Primary Symptom Pattern
Localized symptoms directly at varicose vein sites include: 1
- Pain and aching
- Burning sensation
- Itching
- Tingling
- Skin tightness
Generalized leg symptoms include: 1
- Heaviness in the legs
- Cramping
- Throbbing
- Restlessness (particularly at night)
- Swelling (edema)
Characteristic Temporal Pattern
The hallmark feature distinguishing venous reflux symptoms is their timing: symptoms consistently worsen at the end of the day, especially after prolonged standing, and improve when sitting with legs elevated. 1 This pattern directly reflects the gravitational pooling of blood from incompetent valves.
Progressive Skin Changes
As GSV reflux advances, patients develop visible skin manifestations: 1
- Early changes: Skin irritation and tightness attributable to venous dysfunction
- Moderate changes: Pigmentation changes (hyperpigmentation, particularly in the lower third of the leg), eczema, and cyanotic discoloration 1, 2
- Advanced changes: Lipodermatosclerosis (induration and hardening of skin), stasis dermatitis, and eventual venous ulceration 1, 2
Clinical Severity Correlation
Symptom severity correlates with the extent and location of reflux. Segmental GSV reflux is the most common pattern in early disease (CEAP C2), occurring in 58% of women with simple varicose veins, with reflux segments most frequently located in the leg (58%) rather than the thigh (37%) or saphenofemoral junction (12%). 3
Patients with complicated venous disease (CEAP C4-C6) demonstrate more extensive reflux patterns and higher clinical severity scores compared to those with uncomplicated disease (CEAP C2-C3). 4
Important Clinical Distinctions
A cool, blue leg with pain that does NOT improve with rest or elevation is atypical for isolated GSV reflux and should raise concern for arterial insufficiency or severe venous stasis with compromised tissue perfusion. 2 Standard venous symptoms improve with elevation, so failure to improve warrants immediate arterial assessment with ankle-brachial index before initiating compression therapy. 2
Risk Factors for Symptom Progression
Symptoms worsen more rapidly in patients with: 1
- Family history of venous disease
- Female sex
- Older age
- Chronically increased intra-abdominal pressure (obesity, pregnancy, chronic constipation)
- Prolonged standing occupations
When Symptoms Indicate Need for Intervention
Patients experiencing burning and tightness of the skin with varicose veins should seek medical evaluation, especially if symptoms are worsening, as these may indicate progression to more advanced venous disease requiring intervention beyond conservative management. 1 Referral for interventional treatment should not be delayed for prolonged compression therapy trials when valvular reflux is documented on duplex ultrasound. 1, 2