What Happens With Vein Disease?

One of the most common signs of venous insufficiency is a varicosed vein. These dilated veins are often seen on the inside of the thigh and also the lower leg. As vein disease progresses, veins on other areas of the leg may also become dilated. Larger varicose veins are skin colored and are often bulging. Smaller varicose veins may appear blue or green and are known as reticular veins. Spider veins are the small, blue or purple veins that have almost a spider web-like appearance.

People frequently describe symptoms of a heavy, aching sensation in their legs, which is particularly worse at the end of the day. This can be very painful and can be more severe during menstruation. Other symptoms include itching, throbbing, tingling and burning. Restless Leg Syndrome and cramping of the legs have been linked to varicose veins and vein disease, (but it is unclear if they are directly related).

Since gravity pulls on us each day, fluids tend to be pushed out of the blood vessels into the surrounding tissue. The body is usually able to collect this fluid and return it to the bloodstream. If there is too much pressure, more fluid leaks out and leads to chronic swelling (edema). If the venous pressure is great enough, blood proteins and red blood cells actually can be pushed out of the vessel into the surrounding tissues. The red blood cells have a pigment in them called hemoglobin that is trapped in the tissue and causes a brown staining to occur, most commonly at the ankle. This staining is called hyperpigmentation. This can be worsened by even minor trauma in the area. The proteins and red blood cells in the tissue will cause an inflammatory response by the body leading to thickening and damage to the skin and fat. Eczema (dermatitis) and infection (called cellulitis) can occur in these damaged areas, which are prone to poor healing. The inflammation is called stasis dermatitis and if significant enough, a wound can form called stasis ulceration. These can be very difficult to treat and can last weeks, months, or even years.

As these superficial veins dilate, they hold more blood and the flow inside them becomes more sluggish. When this occurs, blood has more of a tendency to thrombose (clot). If there is minor trauma to these dilated veins there is an increased risk of blood clots. This is called phlebitis and is generally not considered dangerous. When clots involve the deep venous system, however, it is necessary to treat them with blood thinners.

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