CV

aol358 A 36-year-old woman comes to the physician because of large, palpable surface veins in both of her legs. She mentions that they are painful and does not like their appearance. She works as a retail clerk and stands all day, although she has recently taken up running to improve her fitness. Her past medical history is notable for obesity and pregnancy-induced hypertension during her last pregnancy 2 years ago. She says taking up running that has helped her become more fit. Her pulse is 86/min and blood pressure is 125/88 mm Hg. She is 160 cm (5 ft 3 in) tall and weighs 72.6 kg (160 lb); BMI is 28.3 kg/m2. Physical examination confirms the presence large palpable superficial veins along the lateral her legs. A photograph is shown. Which of the following is most likely the direct cause of this patient's current medical condition?

Presumed Caucasian skin in picture insert