Varicose Veins and DVT

A 48-year-old man with a 15-year history of bilateral lower limb varicose veins presents with complaints of heaviness, aching, and mild swelling in both legs that worsens toward the end of the day. He denies any history of DVT, leg ulcers, or skin changes. Duplex ultrasound confirms saphenofemoral junction incompetence with reflux in the great saphenous vein (GSV). He is otherwise fit and works as a software engineer with prolonged sitting. What is the most appropriate initial management?

The image above illustrates the anatomical and physiological differences between a normal vein and a varicose vein. Which of the following is the primary underlying pathological mechanism depicted in the varicose vein?

A 52-year-old woman from Delhi presents with a 3-year history of progressive swelling and heaviness in the left lower limb, worse at the end of the day. On examination, she has dilated, tortuous veins over the medial aspect of the thigh and calf, with mild pitting edema. Trendelenburg test is positive. Duplex ultrasound shows reflux in the greater saphenous vein (GSV) lasting >0.5 seconds. She has no history of DVT. What is the most appropriate next step in management?

A 58-year-old man from Mumbai presents with acute onset swelling, pain, and warmth in the right lower limb over the past 24 hours. He had undergone total knee replacement 10 days ago. On examination, the right calf is swollen (3 cm difference in circumference compared to left), tender, and warm. Homan's sign is positive. D-dimer is elevated at 1.2 μg/mL (normal <0.5). Compression ultrasound shows a hypoechoic, non-compressible thrombus in the popliteal vein extending into the distal femoral vein. What is the most appropriate initial management?

Regarding the pathophysiology and clinical features of varicose veins, all of the following are true EXCEPT: