Veins are a series of interconnected “pipes”, present throughout the human body. The primary purpose of veins is to allow blood to return to the heart. Veins range in size from microscopic, up to 2-3cm in diameter in the torso.
Leg veins can be anatomically divided into two categories, superficial and deep. “Superficial” veins are located relatively close to the skin surface (typically within a few centimeters of the skin surface), whereas “deep” veins are located in the central (deep) muscular compartments of the legs.
Not all “superficial” veins are visible. In fact, the dominant superficial veins in the legs, which are the great saphenous vein and the small saphenous vein, typically to lie 2-4cm underneath the skin surface, and usually are not externally visible.
A subset of “superficial” veins located immediately below the skin can sometimes be externally visible. When present, externally visible skin-surface veins vary in size and degree of visibility. Large veins that bulge through the skin surface >3mm are called “varicose veins”. Tiny veins (<1mm) visible at the skin surface are called spider veins.
Varicose veins are most commonly caused by a underlying condition called “venous reflux”. Venous reflux refers to a situation where the one-way valves in the leg veins are not functioning correctly, which increases back-pressure. The most common veins to be affected with venous reflux are the Great Saphenous Vein and the Small Saphenous Vein, both of which are considered superficial leg veins.
A medical term for the condition where veins in the lower part of the leg are under increased pressure, secondary to valve dysfunction is “chronic venous insufficiency” (CVI).
Another condition that can cause increased pressure in leg veins is venous obstruction. This situation arises when upstream veins become clogged (ie. with clot/thrombus), or narrowed (due to vein scarring, or vein compression). The impact of venous obstruction blood flow is complex and variable. Sometimes blood clots “completely” obstruct blood flow, and on other occasions blood clots are only “partially occlusive”. If a blood clot is partially occlusive, blood can continue to flow around the clot, and there may be minimal pressure-related symptoms in the lower leg.
Symptoms of Varicose Veins & Venous Reflux
- Increased pressure within the leg veins secondary to venous reflux may result in a variety of symptoms including leg heaviness, aching, fatigue, cramping, restlessness, itching or pain.
- Swelling in the lower part of the leg or ankle is common. Symptoms can occur in one or both legs.
- Spider veins and varicose veins can be asymptomatic, but can also cause symptoms of burning, tingling, itching or localized discomfort. In addition spider veins and varicose veins may be of cosmetic concern to many patients.
- Leg symptoms secondary to venous reflux are generally exacerbated by prolonged standing (or sitting) and are relieve by elevation of the leg(s).
- In advanced cases the skin around the ankle may become stained (typically a brown / bronze or reddish color), or develop progressive leathery thickening. In severe cases skin breakdown (venous ulcer) can occur.
Patients with prominent varicose veins or symptoms suggestive of venous reflux merit evaluation by a vascular specialist.
A review of past medical and surgical conditions, current symptoms, medications, and physical examination are routinely performed. The decision about whether to perform adjunctive diagnostic testing is based upon the patient’s symptoms and exam findings.
The most commonly used test to evaluate the structure and the function of the leg veins is “duplex ultrasound”. Duplex ultrasound is a painless study that involves using a hand-held ultrasound probe to shine high-frequency sound-waves through the skin, allowing visualization of the leg veins. The duplex study is able to visualize both the “superficial veins” and the “deep veins” in the legs. If present, abnormalities of valve dysfunction and venous blood clots are readily identifiable.
On an infrequent basis, additional diagnostic tests such as a venogram (injection of dye into the vein supplemented by X-ray imaging), or CT-scanning may be required.
Treatment options for Varicose Veins & Venous Reflux
At Vascular Solutions, venous reflux is treated with ClosureFast™, VenaSeal™, or Varithena™. Please see below for animations of these procedures.
Small varicose veins can sometimes able to be treated with injection of liquid or foam medicine that causes the vein to occlude and shrink. Injection of a liquid or foam solution into a vein is known as sclerotherapy. If the varicose veins are larger, or bulging significantly through the skin, a procedure called phlebectomy may be a preferred option. Phlebectomy involves direct removal of the bulging veins through needle-hole incisions.