FAQ: Venous Disease

Arteries are thick walled vessels which carry oxygenated blood from the heart to the body. Veins are thin walled vessels which carry de-oxygenated blood from the body back to the heart to be re-circulated. There is a third kind of vessel, called lymphatic vessels which are tiny, extremely delicate vessels that carry proteins and lymphatic fluid from the body back to the heart.

Veins, which have one-way valves, channel the deoxygenated blood back to the heart. The one-way valves prevent blood from flowing backward (reflux). If they fail to close properly, blood will leak through the valves and result in pooling. Over time, this pooling will force the vein wall outward resulting in enlargement and bulging of the vein. These enlarged veins are varicose veins. Varicose veins can protrude from the skin surface resulting in a rope-like appearance.

Venous insufficiency is very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don’t close properly, they allow blood to flow backward, a condition called “reflux”. Veins that have lost their valve effectivenessbecome elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in the thigh vein called the greater saphenous, which leads to pooling in the visible varicose veins below.

Symptoms caused by venous insufficiency and varicose veins include aching pain, easily tired legs and leg heaviness, all of which worsen as the day goes on. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms. In more severe cases, venous insufficiency and reflux can cause darkening of the skin and wounds that may be very difficult to treat. One percent of adults over age 60 have chronic wounds known as ulcers. People who have venous insufficiency can have symptoms even without visible varicose veins. The symptoms are caused by pressure on nerves by dilated veins.

Chronic venous disease of the legs is one of the most common conditions affecting people. Approximately half of the U.S. population has venous disease-50 to 55 percent of women and 40 to 45 percent of men. Of these, 20 to 25 percent of the women and 10 to 15 percent of the men will have visible varicose veins. Varicose veins affect one out of two people age 50 and older, and 15 to 25 percent of all adults. People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins, as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.

Spider veins are small red, purple or blue veins located just below the surface of the skin. They can have a web-like appearance, hence, the term spider vein. Most spider veins have an unattractive cosmetic appearance and, in some cases, may give rise to symptoms of itching, burning, or throbbing of your legs. Another type of vein is the reticular vein, which is bluish, deeper than spider veins, and often “feed” the spider vein. These veins need to be treated or the spider veins cannot be eliminated.

Risk factors include age, family history, gender, and pregnancy. In women, pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of the varicose veins. Additional factors, while not directly the cause of varicose veins, may speed up the development of this disease and make the veins worse: prolonged standing, obesity, hormone levels, and physical trauma.

The underlying conditions that cause the problem usually make “curing” varicose veins impossible, however certain measures may help relieve discomfort from existing varicose veins and prevent others from arising such as: regular exercise, avoid long periods of standing or sitting, and control one’s weight. Since the above measures do not treat the underlying cause of the disease, varicose veins will usually enlarge and worsen over time. Legs and feet may begin to swell and sensations of pain, heaviness, burning, or tenderness may occur.

Your physician will usually try methods that don’t involve surgery first to relieve you symptoms. These may include preventive techniques or the use of compression stockings. If your varicose veins do not respond to this conservative therapy, more active treatment may be required. Preventive techniques include lifestyle changes such as: exercise, weight loss, elevating legs, avoiding long periods of standing/sitting, and for more severe cases, compression stockings. Compression stockings will squeeze your veins and attempt to stop excess blood from flowing backwards. You may need to wear compression stockings daily for the rest of your life.

A very painful, open wound where the skin has actually died and the flesh beneath it is exposed. This is caused by extreme reflux and venous hypertension which results in changes in the microcirculation of the skin and over time leads to severe ulceration. This condition indicates the most severe form of venous insufficiency and typically involves both the deep (including perforators) and superficial venous systems.

Ambulatory Phlebectomy is a minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

Sclerotherapy can be used to treat some varicose and spider veins. An extremely fine needle is used to inject the vein with a solution which shrinks the vein. This is often done after vein ablation to improve the appearance of any remaining spider veins.

Following treatment you may develop bruising at the injection site. This is normal and usually resolves in approximately 14 days. Slight staining of the skin or telangiectatic matting (tiny new veins) can occur but is usually temporary. An allergic reaction to the sclerosant is rare. Sclerotherapy is a safe and effective treatment for varicose and spider veins.