Vein Basics

• What are veins?
• What makes the blood move through veins?
• What are varicose veins?
• How common are varicose veins?
• Are varicose veins bad for you?
• Why should varicose veins be treated?
• What can be done for varicose veins?

What are veins?

Veins are blood vessels that return blood to the heart. Arteries carry blood away from the heart. Blood moves in arteries because it is pumped by the heart. The pressure generated by the heart is lost as blood moves down the arteries into smaller and smaller channels, ending in capillaries. These capillaries are so small that red blood cells can only move through them in single file. On the far side of the capillary bed, the vessels join to form larger and larger vessels called veins.

There are two systems of veins in the legs, the deep venous system and the superficial venous system. The deep system lies within the muscles. This deep system is well-supported by the muscles of the legs and rarely causes problems. The superficial system lies just below the skin. It receives very little support from the skin, and it is therefore, prone to problems. It is in the superficial system that spider veins and varicose veins are found.

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What makes the blood move through veins?

As explained above, the pressure generated by the heart is lost in capillary beds, so veins have very little pressure. Because there is little pressure, there has to be a system for keeping the blood moving back to the heart. Therefore, veins contain a system of one-way valves. These valves keep blood flowing toward the heart and prevent blood from flowing backwards.

In the legs, the pressure required to make blood move is generated by muscle contractions as you walk. The muscles squeeze veins of the deep system, and blood flows easily. Most of the pumping action for leg veins is produced in the calves.

In the superficial system muscle action does not squeeze veins, because the skin gives way. These veins depend on a system of perforators, veins that join the superficial veins to the deep veins. Blood moving in the deep veins helps to pull blood through the perforators to drain the superficial veins.

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What are varicose veins?

The formation of varicose veins probably starts with a weakness of the vein wall. This is most commonly inherited. When the vein wall weakens, it gives way under pressure and begins to dilate. Eventually, the vein dilates to a point at which the valve halves can no longer touch, and the valve fails to hold the blood above it. Blood backs up adding to the pressure and dilatation of the vein and causing valves further down the vein to fail. Blood actually starts to flow backwards, down the vein and away from the heart. The vein bulges under the skin. This is a varicose vein.

The increased pressure in the varicose veins will also affect smaller vessels that feed into these varicose veins, and they will dilate. These smaller vessels are known as reticular veins, venulectasias, or telangiectasias (spider veins) depending on their size and location.

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How common are varicose veins?

Varicose veins are an enormous problem. In women they are present in about 30% of thirty year olds, 40% of forty year olds, 50% of fifty year olds, and so on. They are about half as common in men. At any one time, approximately 40% of the population has vein problems.

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Are varicose veins bad for you?

Blood in varicose veins is moving backwards down into the legs instead of up toward the heart. This old blood is full of toxins that are recycling through the legs instead of returning to the lungs, liver, and kidneys to be removed. These toxins cause problems as described in the next question.

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Why should varicose veins be treated?

There are four reasons people chose to treat varicose veins.

• They are unsightly.
• They cause a lot of discomfort in the legs including burning, aching, heaviness, fatigue, and restlessness (the result of backpressure and toxins). They frequently cause swollen feet.
• Longstanding varicose veins can lead to thickened discoloured skin (from long term deposition of blood pigment) and leg ulcers (the result of toxins).
• People with varicose veins are very prone to blood clots in the legs. There are two kinds of blood clots: i) Superficial phlebitis is an inflamed vein just under the skin. It is warm, red, and extremely tender. This type of clot is very common in people with varicose veins, but really amount to nothing more than a nuisance, because clots of this nature resolve spontaneously and rarely travel to the lungs. ii) on the other hand, deep vein thrombosis is very dangerous. As the name implies, these clots occur in the deep vein system. Because they are located in the muscles, rather than just beneath the skin, they are not as easy to detect as superficial phlebitis. And unlike superficial phlebitis, deep vein clots can break loose and travel to the lungs (pulmonary embolism). This is fatal in about 20% of cases. People with significant varicose veins are about nine times more prone to deep vein thrombosis than those without varicose veins.

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What can be done for varicose veins?

Support hose is very beneficial in relieving symptoms and slowing the progression of varicose veins. Hose also reduces the likelihood of complications of vein disease such as leg ulcers and blood clots.

Exercise and maintenance of healthy body weight are also beneficial.

Bioflavonoids found in yellow and orange fruits and vegetables, especially citrus fruits, increase venous tone and improve venous elasticity. Horse chestnut, taken internally or applied as a lotion, decreases capillary permeability and helps to reduce swelling.

The elimination of varicose veins is accomplished using three techniques: sclerotherapy, surgery, and laser treatments.

For several decades, varicose veins were treated either surgically or by sclerotherapy (injections). Both types of treatment have been fraught with complications, recurrences, and failures. However, in the last few years, technological advances have made the elimination of veins far more predictable and far less invasive.

SCLEROTHERAPY :

This safe and effective technique has stood the test of time, having been used since the mid-40s. It involves the injection of various fluids into veins to kill them. These veins subsequently turn into scar tissue and disappear. Veins of all sizes can be treated in this way. The largest veins are treated using ultrasound-guided injections (echosclerotherapy). Ultrasound is used to guide a needle into leg veins that are too deep to see or feel. In the past, these veins could only be treated surgically (vein stripping). The success rate is very high. The recurrence rate is much lower than for surgery. The procedure is very safe, virtually painless, inexpensive, and involves minimal downtime. Please refer to our section on SCLEROTHERAPY for in-depth information.

SURGERY :

Stripping of varicose veins has been done for decades. This procedure is only used to eliminate the largest veins (the greater saphenous and short saphenous veins). It requires a general anesthetic and results in painful wounds, a lot of bruising, and scars. The recurrence rate (development of new varicose veins) is 20-80% depending on the care and skill of the surgeon.

Ambulatory phlebectomy is a surgical technique that can be used to treat medium-sized veins. Under local anesthetic, several tiny incisions are made along the course of the vein, and it is extracted bit by bit through these tiny wounds. When it is done well, it is effective, mildly painful, inexpensive, leaves scars that are virtually invisible, and involves minimal downtime.

ENDOVENOUS TECHNIQUES :

As with stripping, this procedure is only used to eliminate the largest veins (the greater saphenous and in some cases the short saphenous veins). Under local anesthetic, a fiber-optic cable or a wire is inserted into the vein. A laser beam (endovenous laser) or radio frequency signal (RF occlusion) is passed, burning and closing the vein. It requires a lot of local anesthetic. The procedure is very safe, mildly painful, and involves minimal downtime. The success rate is 98-99%. The recurrence rate is 5-10%. It costs $2,500-$3,000 for each leg.

This table summarizes the methods that are available to treat the largest superficial vein, the greater saphenous vein. It runs from the top of the foot all the way up to the groin.