What causes vein disease?
Generally speaking, there are two major types of circulation in the human body. The arterial circulation made up of arteries (muscular tubes) takes blood from the heart to the peripheral tissues and the venous circulation made of thin walled veins returns blood to the heart after oxygen and nutrients have been extracted from it.
Arterial flow depends mostly on the pumping action of the heart and venous flow on the pumping action of the large calf muscles in the legs. Veins are also equipped with one-way valves which assure unidirectional flow towards the heart. In an upright position there is a general tendency for gravity to pull blood back towards the legs. These one-way valves prevent that from happening. When the pumping mechanism in the legs (calf muscle pump) cannot returns blood to the heart through the veins, pressure builds up in the veins and a situation called chronic venous insufficiency (hypertension) ensues.
The pressure inside the deep veins increases considerably as a result of the backflow and poor valve function and some of that pressure is transmitted to the more superficial veins which over time become distended and tortuous and are commonly referred to as varicose veins. They can be seen as bluish tortuous, knotty structures under the skin.
What causes chronic venous hypertension?
The major cause of chronic venous hypertension seems to be increased pressure within the veins. This increased pressure may cause considerable distention of the veins and subsequent damage to the valves. More commonly the valves are noted to be congenitally defective.
Inflammation of the veins (phlebitis) as is commonly seen in deep vein thrombosis may cause scarring of the valves as part of the healing process. These scarred valves no longer open and close as expected, resulting in backflow and increased pressure within the vein.
What are the common symptoms of chronic venous insufficiency?
Increased venous hypertension causes pain and swelling in the lower extremities as some of the fluid under pressure sips from the veins into surrounding soft tissues. This creates a feeling of heaviness, tiredness, achiness and restlessness. Some of the fluid contains breakdown products of hemoglobin, an iron-containing compound, which can stain the skin and cause itching.
What are some of the common factors associated with chronic venous hypertension and varicose veins?
As stated earlier the most common cause of varicose veins and chronic venous insufficiency is increased pressure within the deep and superficial veins. This is found in more than 70% of patients with this condition. Risk factors for chronic venous hypertension and varicose veins include:
- Family history of varicose veins
- Being overweight
- Sedentary lifestyle (lack of exercise)
- Jobs requiring prolonged standing or sitting
- Deep vein thrombosis
Varicose veins seem to be more common in women typically affecting people between the ages of 30 and 70. Pregnant women tend to be most at risk because of the physiologic changes which occurred during pregnancy (a gravid uterus compressing the large pelvic veins and decreasing venous return, expansion of blood volume and relaxing hormones). Varicose veins developed during pregnancy often return to normal within 12 months of delivery.
How common are varicose veins and chronic venous hypertension?
Vein disease is seen in 15-25% of the general adult population and about 50% of people above the age of 50. It tends to be more prevalent in women and persons with a family history.
How do I know if I have varicose veins or chronic venous hypertension?
Varicose veins are small bluish, tortuous veins generally seen on under the skin. Patients with varicose veins and chronic venous hypertension would typically experience symptoms of cramping, achiness, burning, itching, heaviness and dull pain in the lower extremities. The legs may feel tired and restless.
Sometimes patients develop dark or bronze discoloration of the skin. This is typically seen in the distal legs where the patients might also experiences itching and skin breakdown from repeated scratching. If you experience these symptoms Dr. Leke can quickly examine you and determine if you have chronic venous hypertension.
Can varicose veins and chronic venous hypertension be prevented?Congenital abnormalities of vein valves tend to be the major cause of varicose veins and chronic venous hypertension. Therefore the disease cannot be entirely prevented. Obesity and prolonged standing or sitting adds to the problem. No association has been found with your diet, footwear or clotting.
What test do I need for the diagnosis of varicose veins and chronic venous hypertension?
Evaluation of patients with varicose veins is not different from a typical wellness evaluation. We begin by examining your general health, past medical history and associated symptoms, after which we conduct a thorough physical examination. We examine and categorize your varicose veins and other skin changes typically associated with chronic venous hypertension. We may also measure the pressure in your leg veins. To confirm the diagnosis a duplex ultrasound is typically obtained to evaluate functional valve anatomy and exclude deep vein thrombosis and venous obstruction.
Sometimes, Dr. Leke may inject dye into your veins (venogram) to get a better picture of your venous anatomy in cases where he might suspect obstruction as the cause of your symptoms.
What is the treatment of varicose veins and chronic venous hypertension?
Chronic venous hypertension and varicose veins are not life-threatening conditions, but a significant source of nuisance and discomfort to the patient. As a result, our treatment is focused mostly on decreasing pain and disability. We typically begin with more conservative measures such as maintaining an ideal weight or weight loss in overweight patients, regular exercise, avoidance of prolonged standing or sitting, abstaining from tobacco use, leg elevation when sitting at home and the use of graduated compression stockings. Most patients who adhere to these measures generally reported good results.
What happens when conservative measures do not work?
Most cases of chronic venous insufficiency and varicose veins seen in our clinic fall within the mild-to-moderate category. Quiet often we encountered patients with advanced stages of chronic venous insufficiency with extensive skin changes and ulceration who may not respond to conservative measures alone. We generally begin with some form of compression to decrease swelling and heal any existing ulcers that may be present. Most serious cases might involve treatment with injections called sclerotherapy.
Some patients may require corrective surgical procedures such as endovenous laser ablation of the varicose veins, stripping of the varicose veins, ambulatory phlebectomy (avulsion and removal of varicose veins), bypass of occluded vein segments, vein valve repair and occasionally angioplasty and stenting of the stenotic (narrow) or occluded veins segments.