The Spectrum of Varicose and Spider Veins

More people in the U.S. miss productive work time due to vein disease than to arterial disease. The most common leg ulcer in wound care centers across the U.S. is the venous stasis ulcer, not the diabetic ulcer as originally thought. Nearly 5 percent of the U.S. population suffers from some form of leg vein abnormality.

The study of vein disease has not received priority in the past. New interest in diagnosis and treatment began about 8-10 years ago with better treatment options.

The field of vein disease has developed into a sophisticated AMA recognized specialty known as Phlebology.

Varicose veins are those that are abnormally dilated underneath the surface of the skin and do not function normally. The speed of blood traveling in these veins is much slower, and may lead to clumping of red blood cells, resulting in a blood clot. In the superficial venous system this is known as superficial thrombophlebitis. Blood clots in the superficial venous system have the potential to propagate and extend into the deep venous system, having the potential to break off and travel to the lungs, causing what is known as Pulmonary embolism.

Vein Disease

The peripheral venous system functions both as a conduit to return blood to the heart as well as a reservoir to hold extra blood.

The Causes

Valvular incompetence

Most leg vein problems are not cosmetic. They are an inherited condition caused by a malfunction of the in-lying vein valves of the superficial Saphenous veins (larger skin veins). The valves of these veins do not close properly, therefore allowing blood to flow backwards, causing venous congestion or “pooling” of blood in the legs. This results in a marked dilatation of the veins.

Obstruction

Venous obstruction is another possible cause of varicose veins. This may occur either in the proximal portion of the vein or the distal segment of the vein. Obstruction is produced typically by a clot, which may extend either proximally or distally from its origin. Depending on the size of the clot, venous blood may be forced into the superficial or skin veins in a reverse manner. A deep venous clot, once it resolves, can result in permanent scarring of a valve, causing blood to flow backwards, resulting in elevated venous pressures. Constriction of a deep vein can also appear after resolution of a deep vein clot, narrowing its diameter, also resulting in elevated venous pressures distally.

Symptoms

Symptoms of varicose veins are often disproportionate to the extent of venous disease. Varicose vein pain is described as a “dull aching”, “cramping” or “tiredness” of the legs associated with swelling, ”heaviness”, itching and restless legs. Symptoms can also affect the pelvis or lower abdomen. These symptoms are a lot more common in legs with visible disease compared to legs without, and are greater, the more severe the visible disease is. The increased incidence of symptomatic varicose veins in women may have a hormonal cause. It has been estimated that 27.7% of women with varicose veins have pre-menstrual pain in their varicosities.

Pelvic Congestion Syndrome is a condition that typically occurs in young women with multiple births, characterized by chronic pelvic pain associated with pelvic venous varicosities. A small number of women can also experience painful varicose veins after intercourse. Many patients with recurrent leg varicose veins are found to have a component of their problem in the pelvis. Symptoms are more severe in these patients.

Risk Factors

The strongest risk factors for varicose veins are age and family history. Neither one of these risk factors can be corrected by medical or surgical treatment.

Other risk factors include:

  • Hormonal Factors
  • Obesity
  • Prolonged standing
  • Decreased ankle mobility
  • Prior lower limb injury
  • Deep Venous Thrombosis

Consequences

Chronic Venous disease affects millions of people. In some cases this is a tolerable disease, however in some patients, it is recurrent and costly. Patients can deal with symptomatic vein disease without treatment. However, when they have another medical issue that compounds the leg, such as a peripheral neuropathy, osteoarthritis, broken bone, joint replacement surgery of either the hip or knee, or weakness in the leg from a stroke, their symptoms become markedly worse.

Patients can experience more severe pain and also experience skin disease of the leg resulting in rashes of progressive severity, ultimately leading to ulcers. Blood clots can also occur in the leg leading to more irreversible damage. As veins increase in size, they can rupture spontaneously and bleed.

If you are struggling with any vein issues, contact the Skin & Vein Center to get the help you need.