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Vein Disease
Varicose Veins
UNDERSTANDING VARICOSE VEINS
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Oxygenated blood leaves the heart by arteries, passes through capillaries and returns to the heart via veins. When you stand, veins operate against gravity, by using valves and muscles, to return blood back to the heart. The muscles in the calf of the leg help "milk" or push blood back to the heart, while valves within the vein keep the blood from flowing back down toward the feet. About 90% of the blood that returns to the heart travels along the "deep veins." However, superficial veins known as the Greater Saphenous Vein or Long Saphenous Vein carry about 8-10% of the blood that is drained from the skin into the deep system for return to the heart. Varicose veins occur in veins when valves no longer function properly and the wall of the vessel becomes weak. Superficial veins then become large with a knotted appearance and may form abnormal branches. Valves within the "deep venous system" may also malfunction. To date, treatment options for "deep vein" problems remain limited. Most varicose veins, reticular veins (small blue veins seen through the skin), and spider veins arise from the superficial system.
CONTRIBUTING FACTORS
Multiple factors can cause the development of varicose veins:
- Age - the development of varicose and/or "spider" veins can occur at any age; however, they most commonly begin between the ages of 18 and 35 years, and peak between 50 and 60 years.
- Heredity - there is a significant relationship between heredity and the development of varicose and "spider" veins. If your mother or father has varicose or "spider" veins, there is a greater chance that you will develop these abnormal veins.
- Gender - approximately four females are affected to every one male.
- Pregnancy - Approximately 8 to 20% of pregnant women will develop varicose veins; however, some may disappear shortly after delivery. Both hormonal changes during pregnancy and compression of veins by the enlarged uterus can contribute to varicose or "spider" veins.
- Lifestyle or Occupation - People who are involved in prolonged periods of sitting or standing are at increased risk for developing varicose veins. Blood tends to collect in the veins, putting pressure on the valves, thus causing the vein to distend.
COMMON SYMPTOMS
- Pain in the legs or ankles
- Tiredness in the legs
- Heaviness
- Leg and ankle swelling
LESS COMMON ASSOCIATED PROBLEMS
- Inflammation ("phlebitis")
- Thrombosis ("clotting")
- Spontaneous rupture
- Ulcers on the legs
DIAGNOSTIC TESTING
Venous duplex ultrasound is a non-invasive, pain free way to assess the condition of both your deep and superficial veins. Utilizing ultrasound, the technician and surgeon are able to visualize blood flow and the effectiveness of the valves in the veins to prevent blood from flowing down toward the feet ("venous reflux" or "incompetent valves"). This study is performed in the clinic and typically takes 30 minutes.
PREVENTION
Elevate your legs.
Use compression support hose as described above.
Maintain your ideal body weight to reduce excess pressure on your legs.
Avoid prolonged sitting and standing. If this is not an option, move your feet up and down as described above to activate your calf muscle. On long car trips, you should stop every few hours for short walks.
COMMON TERMS
Deep veins - veins located deep in the leg. They are responsible for returning 90-95% of venous blood from the leg back to the heart. Deep vein treatment options are limited at this time.
Superficial veins - these veins are most likely to become varicose veins. They are not supported by muscles like the deep veins. They drain blood from the skin and also store blood. These veins may appear engorged or distended (varicose). Reticular veins are a type of superficial vein that can often be seen through the skin. Spider veins are tiny skin veins; they may have a star pattern.
Perforating veins - these veins link the deep and superficial veins.
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