Vein Conditions

Varicose Veins

Condition

How do I know if I have Varicose Veins?

Varicose veins come in many forms. They can be visible in various sizes of protruding, rope-like veins or knots just below the skin surface. Many become more prominent with prolonged sitting or standing. Problem varicose veins may not be visible at the skin surface however, they may still cause bursts of abnormal red, purple or blue smaller veins, as well as leg symptoms and skin changes of venous insufficiency. In addition to being unsightly, varicose veins are commonly associated with the following symptoms or signs:

Pain, throbbing or cramping
Tiredness and fatigue
Itching and burning
Swelling of the ankles and legs
Heaviness
Restlessness (Restless Legs Syndrome)
Swelling or edema of the ankles and legs

Difference Between Venous Disorders

Spider Veins

Larger than 2,5mm in diameter
Usually have a dark-blue or purple
Veins often protrude above the surface of the skin and can lead to pain, burning and spasms

Reticular Veins

Size about 2mm in diameter
Color varies from green-blue or purple
Often causes burning and itching

Varicose Veins

Measuring about 1-1, 5mm.
Have a pink, red or purple color
Sometimes accompanied by pain or discomfort in the affected area

Do I need Varicose Vein Treatment?

The complications of untreated varicose veins and chronic venous insufficiency may include:

Superficial Phlebitis or Thrombophlebitis

Thrombosis (blood clots)
Leg Ulcers

Venous Dermatitis
Spontaneous Phleborrhagia (bleeding from a vein with minimal or no trauma)

What are Varicose Veins?

Approximately 40 million Americans suffer from venous disease. Veins are responsible for returning blood to the heart. The superficial venous system includes the veins closer to the skin surface that lies above the level of the muscles. Whereas, the deep venous system includes the veins that lie within the muscles. Varicose veins are more common in the legs and lower part of the body because they must function against the forces of gravity. The deep veins are well-protected by the muscles, and they are the primary veins responsible for returning blood back to the heart. The superficial veins are poorly protected and are prone to dilation of the vein walls and valve failure.

Simply put, varicose veins are abnormal veins of the superficial venous system that are not functioning properly and not returning blood to the heart. This failure is typically a result of broken one-way valves, weakened vein walls or a combination of both. Whenever the heart is above the level of the legs, varicose veins will have a backward flow that siphons or steals blood from the deep veins. When the good veins are unable to compensate for the incompetent veins, venous insufficiency results and can cause the various symptoms or complications listed above. Comprehensive vein treatment will improve venous circulation, relieve symptoms, and normal veins are no longer hindered.

What causes Varicose Veins?

Venous ulcers account for up to 90% of leg ulcers. Ulcers are non-healing or poorly-healing open skin wounds. The most common site of venous ulcers is on inner part of the leg just above the ankle. They may also occur on the shin and other areas surrounding the ankle. They are typically not seen on the foot or toes, which are common sites for arterial insufficiency ulcers and diabetic ulcers. Venous ulcers are extremely variable: they can be small or large, shallow or deep, dry and crusty or oozing with drainage, and painless or painful. Venous ulcers are often seen in conjunction with chronic leg swelling and preceded by venous insufficiency skin changes such as:

Genetics

Studies have shown that the tendency to develop varicose veins runs in families. Consequently, genetic factors are considered to be the primary cause of venous issues due to the predisposition of one-way valves to fail, vein walls to be weakened, or a combination of both. The presence of varicose veins in siblings, parents or grandparents will indicate that you are at greater risk.

Gender

The prevalence of varicose veins is higher in women than in men. One reason for the disparity is the hormonal influence of estrogen and progesterone. However, it is estimated that 40% of males have venous disease and males are at higher risk of skin changes related to venous insufficiency.

Pregnancy

Many women will first notice varicose and spider veins during pregnancy. A common area is in the groin. Increased circulating blood volume, hormonal influence, and mechanical compression of the abdomen are felt to be the contributing factors to the development or worsening of varicose veins during pregnancy. However, most varicose veins will be less noticeable after delivery, but will become noticeable again with time due to irreparable damage to the veins.

Age

With increasing age, our bodies lose elasticity in the vein walls, resulting in weakened vein walls, vein dilatation and damage to the venous valves. As a result, the prevalence of varicose increases with age in both men and women.

Lipodermatosclerosis

Gravity plays an important role in the development of varicose veins. Occupations, activities, and lifestyles that involve sitting or standing for long periods of time can cause an increase in blood pressure and volume in the veins and contribute to the development or worsening of varicose veins. Some common occupations of patients that develop varicose veins include:

Teachers
Medical professionals
Bank tellers
Restaurant and Retail professionals such as bartenders and cashiers
Hair stylists
Factory Workers – Prolonged standing or sitting

Obesity

Significantly increased weight, particularly in the abdomen, impedes the venous circulation in the legs. The body must work harder to return blood to the heart, resulting in an increase in blood pressure and volume in the veins.

Congenital and Trauma

Klippel-Trénaunay Syndrome, a congenital disease, and physical trauma are less common causes of varicose veins.

Treatment Options

At Tennessee Vein Center, before initiating any vein treatment of the legs, we perform a comprehensive or screening duplex venous ultrasound, as indicated by your history and exam. Duplex venous ultrasound (mapping) can identify if underlying veins are not functioning normally and the severity of the problem. After the mapping, each patient receives a comprehensive treatment plan. Depending on the locations and size of the problem veins, many patients require endovenous thermal ablation treatment of underlying abnormal veins followed by a series of ultrasound-guided or visual sclerotherapy to eradicate the bad veins. The outside of the leg does not have to look terrible for the veins below the surface to be bad. The maps below show the progression of treatment as well as a before treatment and after treatment picture of the leg with venous disease.