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Varicose Vein Basics
Normal Leg Vein Anatomy
The anatomy of the leg veins is similar to the root system on a plant. There are small hair-like roots out at the very ends of the plant that take in the water. These then drain into medium sized roots and then into large branches and finally into the main stem. The same is true of leg veins. Small microscopic veins called veinules collect the deoxygenated blood that has been "used up" and drains into medium sized veins and then into large branches and finally into the main stems. There are two main stems in each leg. They are the greater saphenous and lesser saphenous veins.
The leg has two separate vein systems. The superficial vein system is just under the skin and is the one that can become varicose. The Deep system is down near the bone and very rarely has varicose problems. Veins rely on one-way valves to keep the blood moving uphill against gravity.
One Way Valves
Causes of Varicose Veins
Varicose veins are usually a genetic disease passed down in family lines. Both men and women are affected. An estimated 30-40% of Caucasians are affected by this disease. Caucasian, Hispanic, and Asian decent all are susceptible. There is less of a problem in African American, and Native American people.
Certain aggravating factors do seem to accelerate the development of varicose veins and sometimes are the outright cause. These include pregnancy, heavy work requiring lifting and straining, standing for long periods of time (especially on hard surfaces like concrete), and obesity. In these situations gravity and increased pressure in the abdomen try to force blood back down the leg (retrograde blood flow). Hormonal changes, smoking, and level of fitness also play roles.
This results in too much pressure for the already weakened vein walls and they begin to stretch like water balloons. This in turn separates the valves and they can no longer protect against backward flow. Unfortunately as more and more veins stretch, more veins downstream will be affected. Thus, varicose veins seem to 'grow'.
Problems Associated With Varicose Veins
Pain: Symptoms such as aching, burning, tightness, and simply pain.
Sensation Disturbance: Sensations of itching, tingling, and burning.
Swelling: This ranges from mild to severe. It may also come and go throughout the day.
Spontaneous bleeding: Varicose veins can become very superficial and actually erode through the skin and bleed without warning. Slight injuries such as a scratch can lead to this as well.
Spontaneous Bleeding
Stasis Dermatitis: This skin condition characterized by brown to red discoloration, itching, scaling, and decreased skin sensation is the result of poor vein circulation known as venous insufficiency.
Statsis Dermatitis
Stasis Ulcer: Ulceration usually only occurs when stasis dermatitis has become severe and the general health of the skin is very poor. However, ulceration can occur in people with varicose veins that do not have obvious signs of dermatitis yet. It usually takes months for these to heal and treatment of the varicose veins is usually required to accomplish it.
Varicose Vein Types
1. Greater and Lesser Saphenous Incompetence
These two main stem veins can be distended and the valves can be dysfunctional. When this occurs the person is likely to develop varicose veins in side branches.
Treatment: Endoluminal ablation is the latest innovation in therapy for these veins and is quickly replacing traditional vein stripping surgery. To learn more about endoluminal ablation click here: Endoluminal Ablation
2. Large distended varicose veins
These are the main branches that come off of the main stem veins. These are typically very distended and twisted veins that are often times raised above the level of the skin and are twisted in appearance.
Treatment: Ambulatory phlebectomy is a newer treatment that also has replaced vein stripping. This is sometimes referred to as a 'mini-stripping'. This is sometimes combined with tying the vein off known as ligation. To learn more this treatment click here: Ambulatory Phlebectomy
3. Reticular varicose veins
These medium size veins make up the complex network that interconnects the larger branches. These can become varicose and discolored blue or purple. They also often feed into areas of spider veins when they become incompetent.
Treatment: Sclerotherapy injections are the mainstay of treatment for this size varicose vein. To learn more about sclerotherapy click here: Sclerotherapy injections
4. Spider veins (Telangectasias).
These are the fine red to purple veins that are usually very small and can look very much like a bruised spot. They can take on different shapes such as fan-shaped, linear, starburst, and spider web designs.
Spider Veins
Treatment: While sclerotherapy can be very effective for these, laser treatments have become increasingly popular and are extremely effective. To learn more about laser treatment click here: Varicose Vein Laser Treatment
Conservative Treatment
These make up the non-invasive forms of treating varicose veins. Most providers will recommend a short 3-6 month trial of conservative treatment before beginning more aggressive therapy. These almost never eliminate the varicose veins, but may improve the symptoms of pain and swelling. These include the following:
1. Compression Socks worn during the waking hours.
2. Elevating the legs frequently during the day.
3. A good exercise routine to encourage good muscle tone.
4. A trial of non-steroidal anti-inflammatories such as Ibuprofen.
Insurance companies almost always require that a period of conservative therapy be tried before they will authorize any of the above treatments. (See our insurance authorization article for more information).