Veins are present in a wide variety of sizes (ranging from microscopic, up to 2-3cm diameter in the torso). Although the diameter and precise anatomic location of veins have some degree of variability, veins in the legs can generally be divided into two categories (“superficial” veins and “deep” veins). The “superficial” veins are located relatively close to the skin (or within a few centimeters of the skin surface), whereas the “deep” veins are more centrally located in the deep muscular compartments of the legs.
Although less common than valve dysfunction, other potential causes of increased pressure within the veins in the lower leg can occur when upstream veins become clogged with clot (thrombus), or narrowed due to scar tissue. The relationship between a venous blood clot and the current (or ultimate) effect of venous blood-flow is complex. Sometimes blood clots can completely obstruct venous blood flow, and on other occasions, blood clots are only “partially occlusive”, in which case blood can continue to flow around the clot.
The catch-all medical name for a condition where the veins in the lower part of the leg are under increased pressure is “chronic venous insufficiency” (CVI).
Symptoms of Varicose Veins
- Increased pressure within the leg veins associated with chronic venous insufficiency may result in a variety of symptoms including heaviness, tiredness, aching, itching, or pain.
- Swelling in the lower part of the leg or the ankle is common. Symptoms can occur in one or both legs.
- Spider veins and varicose veins can be asymptomatic but may result in 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 insufficiency are generally exacerbated by prolonged standing (or sitting) and are relieved by elevation of the leg(s).
- In advanced cases of venous insufficiency, the skin around the ankle may become stained a brown color or may develop progressive leathery thickening. In severe cases, wounds or ulcers can also occur.
Patients with prominent varicose veins or symptoms suggestive of venous insufficiency 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 function of the veins in the legs 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 function and venous blood clots are readily identifiable.
On an infrequent basis, additional diagnostic tests such as venogram (injection of dye into the vein supplemented by X-ray imaging), or CT-scanning are required.