contact Dr. Busselberg

An understanding of varicose veins and venous insufficiency begins with understanding the unusual arrangement of the veins in your legs. You really have two venous systems. You can see the superficial veins under your skin. When these become dilated and tortuous, they are called varicose veins. The word "varicose" comes from the Latin for dilated. The longest and largest of these veins is connected to the femoral vein and courses down the inner aspect of your thigh and leg. It is called THE GREATER (longer) SAPHENOUS VEIN. Another large superficial vein begins behind the knee and runs down the back of the calf of your leg. It is THE LESSER (shorter) SAPHENOUS VEIN. Both have branches that extend under the skin.

The second venous system in your legs, comprising the deep veins, begins with the femoral vein and runs deep inside the leg muscles. The deep veins carry the greatest portion of blood from your legs to be returned to your heart. That is no small amount, as the leg veins may hold as much as 70 percent of your total blood volume, depending on your posture.

The superficial veins are connected to the deep veins by short veins called PERFORATING VEINS. It is important to realize that the superficial veins drain through these perforating veins directly into the deep veins. As blood flows faster and faster through the deep veins to return to your heart, the flow literally sucks blood out of the superficial veins and empties them. If the deep veins are obstructed, that will affect the superficial veins as well. But you can have abnormalities of the superficial veins and have normal deep veins. This is often the case when one has uncomplicated varicose veins, without symptoms.

Another unique feature of the veins in your legs is that they have valves. These are just two flaps that open and allow the blood to flow toward your heart. They float open with the blood flow. They flap together to prevent the blood from flowing backward toward your toes. There are two distinct features of varicose veins. First, they are swollen and dilated, and second, the valves inside them do not work. The veins are thin-walled, but they do contain a muscular layer and elastic fibers. When the elastic and muscular layer are overstretched, the vein is a lot like a balloon that has been blown up too often - a dilated sac. Because of the vein's dilation, the flap-like valves do not quite meet. They cannot prevent blood from flowing backward toward your toes. As a result, when you are standing, the blood tends to run downhill and accumulates in the vessels in your lower legs, causing discoloration and swelling.

There are also valves in the perforating veins to prevent blood from flowing backward out of the deep veins into the superficial veins. When a perforating vein is dilated, its valves are incompetent, too. The point where it connects to the superficial veins may be especially large and rounded under the skin. These points are sometimes called "blow-outs."

Varicose veins are abnormally stretched or swollen veins that protrude from the surface of the skin in a rope-like manner. Generally found on the legs, varicose veins are the result of faulty vein valves or weak vein walls.

Spider veins, or broken capillaries, are medically referred to as telangiectasias. They are dilated capillary veins less than 2mm in diameter that exist just below the surface of the skin on the legs or face. Spider veins are blue, red, or purplish in color with a web-like or linear appearance.

What Happens

Leg vein problems begin when the vein valves that prevent blood from flowing in the wrong direction (reflux) become weak or malfunction. This causes blood to pool in the veins, forcing them to protrude from the skin becoming tortuous or rope-like and varicose. This increased venous pressure can lead to further failure of other vein valves and to the development of varicose veins.

In addition to being unsightly and even embarrassing, varicose veins and spider veins can cause varying degrees of discomfort, including:

- swelling
- throbbing
- heaviness
- aching
- leg cramps

Varicose veins are a progressive disease that can eventually lead to ankle swelling, pigmentation, ulceration, bleeding, and advanced Chronic Venous Insufficiency (CVI). It is important to seek medical treatment early in order to stop the natural progression of this disease, and reduce symptoms to achieve the best possible cosmetic results.

Spider veins often occur in conjunction with varicose veins due to increased venous pressure. They also develop on their own due to an increased number of shunts, or microscopic short-cuts, connecting the venous and arterial systems.

In women, varicose veins can manifest itself in the genital area – pelvic congestion syndrome. Pelvic congestion syndrome is caused by poorly functioning veins in the ovaries and pelvic region, which can result in varicosities in the abdomen, buttocks, vulva, and legs. Women that suffer from a generalized aching in their pelvic area, especially when standing, lifting, or after sexual intercourse, may suffer from this condition. With today’s advanced diagnostic tools, doctors can now easily identify pelvic congestion syndrome in women.

Causes
While no one knows what causes varicose and spider veins, we do know that a number of factors can increase the likelihood of developing leg vein problems. We also know that the primary factor contributing to the development of varicose and spider veins is heredity, or the genetic predisposition to weak vein walls and vein valves resulting in leg vein problems.

There are also a number of lifestyle variables known to accelerate and aggravate the development of varicose or spider veins: