Common Vein Problems

More than 80 million people in the United States have problems with their veins, the vessels that return blood to the heart once it has circulated through the body (as opposed to arteries, which carry oxygen-rich blood from the heart to the body).

The most common manifestations of venous disease include venous thromboembolism (VTE) and chronic venous insufficiency (CVI). Considering the range of venous disease, public awareness remains vital to the possibility of improving outcomes of prevention, identification, and treatment.

Many people suffering from venous disorders come to vascular surgeons looking for treatment either to relieve pain or improve the visible appearance of diseased veins.

Normal Veins

There are two sets of veins in our legs: deep veins and superficial veins. The function of the veins is to return the blood from the periphery to the heart.

The deep veins are large, located deep between the muscles, and carry most of the venous blood up towards the heart.

The superficial veins are located close to the skin and are connected to the deep veins through a number of communicating channels called perforators. There are two main trunks of superficial veins called saphenous veins. The great saphenous vein is on the inner side of the thigh and joins the deep veins (femoral vein) in the groin. The small saphenous vein is located on the back of the leg and joins the deep veins (popliteal vein) behind the knee.

Our heart is a mechanical pump that forces the blood to flow through the arteries into the rest of the body, but we do not have a pump in our feet to return the blood to the heart. When we walk or run, our calf muscles contract and squeeze the deep veins, pushing blood to flow upwards. This is known as the calf muscle pump.

Veins have one-way valves that help keep blood flowing in the proper direction: towards the heart and not away from the heart. If these valves stop functioning the way they are supposed to, blood can flow backwards (reflux) and pool in the vein, causing it to stretch.

These enlarged blood vessels are classified into two main groups: spider veins and varicose veins. Spider veins are visible on the surface of the skin as red, blue or purple lines; varicose veins are larger and deeper and often manifest as bluish bumps beneath the skin.

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Spider Veins

Spider veins are caused by a variety of factors, including heredity, pregnancy (and other conditions that involve changes in hormone levels), weight gain, long periods of standing, and certain medications. Spider veins appear as small red, blue, or purple threads easily visible on the surface of the skin, often creating unsightly and unpleasant appearances. Occasionally they cause symptoms such as pain, fatigue, burning and itching. Spider veins are often considered a cosmetic problem and not a real disease, although in reality they are tied to the same mechanisms involved in varicose veins disease. Spider veins cannot be treated effectively unless the problem of high venous pressure is addressed.

For more information on spider veins, click here.

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Varicose Veins

Varicose veins are swollen, dark blue or purple blood vessels that are visible and palpable beneath the skin. They often look like twisted cords, and usually appear on the calves, inside areas of the legs, and ankles. Most people with varicose veins seek cosmetic treatment to conceal their appearance on the legs. Treatment often also takes care of the discomfort associated with the condition such as swelling, fatigue, itching and cramps.

Sometimes, however, more significant problems can develop if veins are left untreated. Venous insufficiency occurs when blood cannot be efficiently returned to the heart. This, in turn, can lead to further symptoms, such as pain, aching, pigmentation, swelling, inflammation, bleeding and skin ulcers. For this reason, patients with varicose veins should be examined by a medical professional familiar with the full spectrum of signs and symptoms caused by chronic venous disease.

For more information on varicose veins, click here.

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Bleeding Varix

When varicose veins are not treated properly, they may stick to the undersurface of the skin and eventually break through the skin and bleed. The skin covering a tense, bulging varix is usually thinned and has a bluish discoloration.

Bleeding can happen spontaneously or as the result of a minor trauma, often creating panic for patients and family, and frequently resulting in a trip to the Emergency Room.

For more information on bleeding varix, click here.

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Venous Insufficiency

As varicose veins evolve and the valves are less and less able to hold the blood from coming down—a phenomenon called reflux—very high pressure and congestion develops in the lower leg area. This condition is called chronic venous insufficiency and has very serious consequences. Patients develop persistent swelling of the leg with skin discoloration and inflammation.

For more information on venous insufficiency, click here.

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Stasis Dermatitis and Ulceration

When venous valves are not working properly or are destroyed, the pressure in the veins of the lower legs is higher than normal. High venous pressure will cause the fluid and certain blood components to seep through the wall of the capillaries and accumulate under the skin, causing swollen legs (edema). The health of the skin is badly damaged because oxygen and nutrient materials cannot reach the skin easily. This will result in the thickening and pigmentation of the skin which is known as stasis dermatitis. Finally a segment of the skin dies and ulceration develops. Stasis ulcers are extremely difficult to treat.

For more information on stasis dermatitis and ulceration, click here.

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