Varicose veins are dilated blood vessels that bulge at the surface of the skin. They occur as a result of poorly functioning one-way valves located in all the veins of the legs. These valves are designed to overcome the downward pull of gravity. Malfunction of these valves is call superficial venous reflux. This impedes the return of blood back to the heart. Over time, the blood pressure in these veins and their branches increases resulting in varicose veins.
Most patients become symptomatic. Symptoms are frequently subtle and may come on gradually over a period of years; for this reason, many patients don’t realize they are symptomatic and frequently attribute the way their legs feel to “aging” or being “out-of-shape.” Typical complaints are:
- “Tired” legs
- Dull ache
- Throbbing pain
- “Restless legs”
- Itching and burning
- Hyperpigmentation- a bronze discoloration of the lower legs
These symptoms are often worse towards the end of the day; many patients experience problems at night when in bed. Patients with certain jobs that require prolonged standing or sitting often experience significant discomfort during or after work.
Aside from these symptoms, untreated superficial venous reflux may affect the health of the overlying skin of the lower legs and ankles, causing discoloration and thickening. This may progress to skin breakdown or ulceration.
In some cases, blood clots may develop within varicose veins leading to pain, tenderness and swelling (superficial venous thrombophlebitis, or SVT). Though uncommon, these clots may progress to deeper veins causing deep vein thrombosis. Clot in deep veins can potentially break loose and travel to the lungs, causing potentially fatal pulmonary embolism.
Spider veins, or “telangiectasia,” are small, dilated, web-like blood vessels located near the skin surface. These veins may become dilated due to multiple factors including genetics, hormonal influences (estrogen & progesterone), pregnancy and injury. While they can cause significant emotional discomfort, they typically do not cause pain.
However, if spider veins are associated with symptoms (leg heaviness, fatigue, cramps, “restless legs,” swelling) superficial venous reflux may also be present in larger veins as described above.
Other Vein Conditions
This is a break in the integrity of the skin due to underlying venous disease. These ulcers typically occur in the inner aspect of the lower legs.
Restless Leg Syndrome (RLS)
This is a condition that is frequently associated with venous disease. Patients experience a need to move their legs in order to feel comfortable.
The lymphatic system is a network of channels that rid the body of toxins and waste products. These channels transport lymph, a fluid that contains infection-fighting white blood cells. Lymphedema is swelling that results from blockage of the flow of lymph. Lymphedema is, therefore, not venous disease. However, patients with severe venous swelling may be misdiagnosed as having lymphedema. Patients with true lymphedema may also have coexisting venous disease. Therefore, most patients diagnosed as having “lymphedema” should have a venous ultrasound to rule out the presence of venous disease.