What is Vein Disease?
Arteries and veins are the vessels that transport blood to and from various parts of the body. Arteries are muscular, thick vessels that carry blood away from the heart and veins are the thinner vessels that return blood to the heart. Blood returning to the heart from the legs has to flow against gravity. Between heartbeats, the veins have to support the weight of the blood. To help with this, the veins have valves that open and close to keep blood flow moving in one direction and decrease venous pressure. If the valves fail, due to disease or damage, blood is pulled by gravity down the leg in reverse direction and can pool. The weight of the blood puts excessive pressure on the veins, causing them to elongate and dilate. As they enlarge, they become visible on the legs as varicose veins, or spider veins. This is known as chronic venous insufficiency or vein disease.
Millions of people have some form of vein disease. Many factors contribute to chronic vein disease and the development of varicose veins, including genetic and environmental factors. Certainly, if multiple family members have problems with varicose veins, then you might have more of a tendency for vein problems. Even if there is no significant history of vein disease in the family, your genes may play a role and make you more prone to problems. Our lifestyle is also a factor. People who stand or sit for prolonged periods of time, individuals who are overweight and less active, those with a history of blood clots or injury, and women who have multiple pregnancies are at increased risk of problems.
Women generally suffer from venous insufficiency more than men. Hormones such as estrogen and progesterone play a role throughout a woman's life, especially during pregnancy. Women taking birth control pills and those who have had multiple pregnancies have a greater risk of venous disease. Pregnancy exposes women to significant alterations in the levels of these hormones and increases the circulating blood volume. Furthermore, as the baby enlarges, it puts more pressure on the veins of the pelvis. These factors, combined with the increase in intra-abdominal pressure from the baby, make it more difficult for the blood from the legs to return to the heart. These factors increase pressure in the leg veins, causing them to dilate. Fortunately, after the baby is delivered, the hormones and fluid changes return to normal and some of these dilated veins may regress. Subsequent pregnancies will cause similar changes and possible progression of the vein problems.
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.
It is important to understand vein disease and how it affects you and what you can do to help keep your veins healthy. It is also important to realize that there is help and that there are new, minimally invasive treatments available. Furthermore, it is critical that you understand that varicose veins are more than just a cosmetic issued and may represent a significant underlying problem that deserves treatment.
Minimizing Risk Through Lifestyle Changes
You can personally minimize your risk factors for vein disease by altering your lifestyle or habits. Compression stockings are a crucial component of vein disease treatment. When worn, they support the legs, reducing the pressure in the veins and also, the amount of blood that is "pooled" in each vein. If the veins are supported, they are less likely to progressively dilate and if there is less blood in the varicosed vein, less chance of forming a clot. These stockings also help control the swelling in the legs at the end of the day, and therefore, reduce the risk of eczema and ulcer formation. Today, stockings are more "user-friendly" than those you saw your grandmother wear. They are sheerer and come in multiple colors and colors and styles to fit your lifestyle and activities.
If you are overweight, talk to your doctor about ideal body weight and establish a plan to achieve that goal. Weight loss can help reduce the venous pressure in the legs and the veins may become less prominent. Regular exercise such as walking or biking is important. Exercise activates the muscles of the legs and helps reduce pressure in the veins of the legs. If your job requires that you stand for prolonged periods, try to move your legs and flex your feet up and down intermittently. Periodically elevate your legs during breaks while at work. Even brief periods of elevation can effectively reduce venous pressure. Compression stockings are very important in these situations.
Skin care is crucial. A simple step in preventing the wound complications of venous disease is to apply moisturizing cream to the skin twice daily. This helps avoid eczema or dry skin, which is more prone to injury and infection. Finally, it is important to understand your family history. If there is a significant history of vein problems involving other family members (including varicose veins, sores, wounds or blood clots), you may be at greater risk. You should consult with your doctor.
Vein Disease Treatment Options
Even though venous disease has been documented and studied since the times of the Egyptians, there is still much to understand. As we learn more, there are improved techniques to help people treat these problems.
VenaSeal™ is the newest vein treatment and uses an advanced medical adhesive deliver through a small catheter. Once the affected vein is closed, blood is immediately re-routed through other healthy veins in the leg.
Endovenous ablation can be performed with laser or radiofrequency energy. The vein is treated by making a small 3-4 mm (1/8 inch) incision in the skin, a radiofrequency device or laser fiber is placed into the vein, activated and slowly withdrawn, closing the vein.
Sclerotherapy has long been an important vein disease treatment option for patients with venous disease. Frequently used for treatment of spider veins, newer techniques allow this in-office procedure to also be used for larger varicose veins. A tiny needle is introduced into the varicosed vein and a solution is injected that will cause the vein to sclerose or close off. There is minimal discomfort with sclerotherapy and normal daily activities resume immediately.
Bulging veins that cannot be treated with endovenous ablation or sclerotherapy can be surgically removed through small incisions. This in-office treatment is called microphlebectomy and is often combined with endovenous ablation and/or sclerotherapy for maximum results.
Vein disease is a progressive condition that can result in significant health problems if untreated. It is not strictly cosmetic and may require multiple vein treatments now and in the future. If you are unsure if you have spider veins or varicose veins, Mountain Medical's Vein Center can help you determine the extent of your condition and your options for vein treatment. Knowing your risk factors and options will help you and your vein doctor decide on a customized vein treatment plan that is most appropriate for you.