Primary varicose veins are a common affliction of the lower extremities, whereas the upper

extremities are rarely I affected for reasons not entirely clear. Presumably, the cause of upper
extremity primary varicose veins is the same as lower extremity varicosities, that is, collagen
defects in the vein wall resulting in weakness and dilation. One would expect certain cohorts to
be afflicted with this condition, such as weightlifters or heavy laborers. Certainly patients with
lower extremity varicosities should be at some risk for development of upper extremity
varicosities. In the past several years, we have encountered a total of three patients with the
unusual condition of primary varicose veins of the upper extremity. A varicose vein may be
defined as a vein that becomes elongated, dilated, tortuous and thickened due to continuous
dilatation under pressure. Primary varicose veins are a common affliction of the lower
extremities whereas the upper extremities are rarely affected. The literature has little reference as
regards the number of cases, causes and management of upper limb varicose veins. Congenital
arteriovenous fistulae or iatrogenic arterioverious fistulae for haemodilaysis causes upper
extremity varicose veins. Congenital vascular anomalies, the Klippel Trenaunay Syndrome and
the Parkes Weber syndrome are other rare causes of arm varicose veins. Venous outflow
obstruction caused by subclavian vein thrombosis can be another uncommon cause.
Although there are several possible causes for varicose veins, the most accepted theory is a
congenital defect in the structure of the vein wall. Abnormalities demonstrated in varicose veins
include increased collagen deposition in an irregular fashion, separation and thinning of smooth
muscle bundles, decreased elastin with a net increase in the collagen/elastin ratio, and vacuolated
endothelial cells with pylmotic nuclei. These changes in the vein wall can occur segmentally and
also develop to a lesser extent in veins that have not yet become varicose in those patients with
other overt varicosities. Funcctionally, varicose veins show decrease contraction and relaxation
when compared with normal veins.3 Other factors may also play a secondary role in the
development of varicose veins. Primary valvular incompetence, caused by floppy valve cusps, is
well recognized as a cause of deep venous reflux. This condition likely exists in the superficial
system as well with the resulting reflux leading to venous dilation. Small arteriovenous fistulas
have been suggested as an etiologic factor by causing increased flow resulting in varicose veins,
because anastomoses between arterioles and varicose veins have been demonstrated both
angiographically and by microsurgical dissection. Incompetent perforating veins have been
implicated in the development of lower extremity varicose veins. However, in the arm, the
valves in the perforating veins are oriented toward the superficial veins, thus excluding this as a
cause of upper extremity varicose veins.

LCDR Harold J. Welch, MC, USNR, and J. Leonel Villavicencio, MD, Primary varicose veins of
the upper extremity: A report of three cases
Benjamin N.JacobsMDa, Elizabeth A.Andraska, BSbAndrea T.ObiMDb, Thomas
W.WakefieldMD, Journal of Vascular Surgery: Venous and Lymphatic Disorders
Volume 5, Issue 3, Pages 460-467, May 2017