Vascular Health

Arteries pump oxygen-rich blood FROM the heart; veins return oxygen-depleted blood TO the heart.

Deep leg veins return blood directly to the heart and are in the center of the leg, near the bones. Superficial leg veins are just beneath the skin. They have less support from surrounding muscles and bones than the deep veins and may thus develop an area of weakness in the wall. When ballooning of the vein occurs, the vein becomes varicose. Perforator veins are connections between the superficial system and the deep system of leg veins.

Varicose veins are swollen, twisted, blue veins that are close to the surface of the skin. Because valves in the veins are damaged, they hold more blood at higher pressure than normal. That forces fluid into the surrounding tissue, making the leg swell and feel heavy.

Unsightly and uncomfortable, varicose veins can cause swelling in the ankles and feet and itching of the skin. They may occur in almost any part of the leg but are most often seen in the back of the calf or on the inside of the leg between the groin and the ankle. Left untreated, patient symptoms are likely to worsen, possibly leading to ulceration.

The normal function of leg veins — both the deep veins in the leg and the superficial veins — is to carry blood back to the heart. During walking, for instance, the calf muscle acts as a pump, contracting veins and forcing blood back to the heart.

To prevent blood from flowing in the wrong direction, veins have numerous valves. If the valves fail, blood flows back into superficial veins and back down the leg. The resulting venous reflux causes veins to enlarge and become varicose. The process is like blowing air into a balloon without letting the air flow out again. As a result, the balloon stays swollen.

Treatment, in essence, stops this reverse flow at the highest site or sites of valve failure. In the legs, veins close to the surface of the skin drain into larger veins, such as the saphenous vein, which runs up to the groin. Damaged valves in the saphenous vein are often the cause of reversed blood flow back down into the surface veins.

The distance from the feet to the heart is the farthest blood has to travel in the body. Due to the force of gravity, those vessels experience a great deal of pressure. If vein valves can’t handle it, the backflow of blood can cause the surface veins to become swollen and distorted.

Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, and past vein diseases such as thrombophlebitis, an inflammation of a vein as a blood clot forms. Women suffer from varicose veins more than men, with half the people over age 50 suffering from the condition.

Varicose veins may ache. Feet and ankles may swell towards the end of the day, especially in hot weather. Varicose veins can get sore and inflamed, causing redness of the skin around them. In some cases, patients may develop ulcerations.

Venous ulcers are areas of the lower leg where the skin has died and exposed the flesh beneath. Ulcers can range from the size of a penny to completely encircling the leg. They are painful, odorous open wounds which weep fluid and can last for months or even years. Most leg ulcers occur when vein disease is left untreated. They are most common among older people but can also affect individuals as young as 18.

ESES (pronounced SS) is an easy way to remember the conservative approach. It stands for Exercise Stockings Elevation and Still. Exercising, wearing compression hose, elevating and resting the legs will not make the veins go away or keep them from getting worse because the underlying venous reflux disease has not been addressed. However, it may provide some symptomatic relief. Losing weight also helps.

If there are inflamed areas or an infection, topical antibiotics may be prescribed. If ulcers develop, medication and dressings should be changed regularly.

There are also longer-term options alternatives for visible varicose veins, such as sclerotherapy and phlebectomy.

A chemical injection, such as a saline or detergent solution, is injected into a vein causing it to “spasm” or close up. Other veins then take over its work. This may bring only temporary success and varicose veins frequently recur. It is most effective on smaller surface veins, less than 1-2mm in diameter.

Used for treating surface veins, ambulatory phlebectomy is a surgical procedure in which multiple small incisions are made along a varicose vein and it is “fished out” of the leg using surgical hooks or forceps. The procedure is done under local or regional anesthesia, either in an operating room or an office procedure room.

If the source of the reverse blood flow is due to damaged valves in the saphenous vein, the vein may be removed by a surgical procedure known as vein stripping. Under general anesthesia, all or part of the vein is tied off and pulled out. The legs are bandaged after the surgery but swelling and bruising may last for weeks.

If the source of the reverse blood flow is due to damaged valves in the saphenous vein, the vein may be removed by a surgical procedure known as vein stripping. Under general anesthesia, all or part of the vein is tied off and pulled out. The legs are bandaged after the surgery but swelling and bruising may last for weeks.