Dr. Magnant Nero considers the venous system as a whole rather than as individual parts. The deep system of veins within the muscular compartments of the legs communicates with the superficial system of veins under the skin and fatty tissue (outside the muscles) through a network of communicating veins which act as bridges between the two systems.
The deep system returns more than 95% of the venous blood from the legs to the pelvis, while the superficial system accounts for 5% or less. Since leakiness in the superficial veins is responsible for more than 95% of patients’ problems seen at Vein Specialists, ultrasound evaluation of the lower extremity venous systems is an integral part of their comprehensive venous workup. This evaluation will ensure that any underlying vein problems are identified, and, if necessary, corrected before treatment of the external signs of venous disease is initiated. For example, prior to removing bulging veins in the calf, it is important to first identify the underlying leaky vein and seal it, thereby decreasing the chance that other bulging veins will develop in the future.
Approximately 30 million adults in the United States may suffer from treatable, symptomatic, superficial venous insufficiency. Many of these patients as well as their primary care or specialty physicians may not be fully aware of the advances made in the treatment of venous insufficiency in the last 5-10 years. Since 2000, vein stripping has been replaced by endovenous closure procedures as the preferred treatment of patients with symptoms related to saphenous vein and other superficial venous insufficiency. Many patients once thought to have untreatable venous problems may now be excellent candidates for endovenous closure.
Veins are blood vessels which return blood from various parts of the body to the heart after the blood has circulated through the tissues and organs. To overcome the force of gravity, leg vein blood must be pumped upward through one-way valves that open toward the heart allowing venous blood flow back to the pelvis. The valves normally close between muscle contractions to prevent reflux of blood back down through the veins below the level of the groin. When valves fail to function properly, and open in the opposite direction beyond the normal checkpoint, the condition known as venous insufficiency or venous reflux disease occurs. The higher pressure which results leads to the development of bulging varicose veins, oozing of serum (water and protein) out of the veins into the surrounding tissues resulting in edema (swelling) and other complications.
The more advanced complications of skin discoloration and eventual scarring of the skin and fat to the underlying muscle (lipodermatosclerosis) may lead to the development of recurrent skin infections and venous ulcerations. The longer this condition is present the more damage from the leaking serum (red and white blood cells) will occur. With modern and accurate diagnostic testing, and effective minimally invasive treatments such as endovenous closure, a more proactive and preventative approach to venous insufficiency is clearly warranted to reduce the long term complications of this disease.
The most common clinical presentations of venous insufficiency include spider veins and varicose veins. Spider veins are smaller, more superficial veins, resulting in a network of red and purple spider web like marks on the legs. Varicose veins are larger, swollen, blue and purple ropey veins easily visible on physical exam. Large varicose veins may throb, hurt or itch and on occasion my clot off or bleed through the skin. Varicose veins occur when the one way check valves in the superficial system of veins fail to close tightly. The veins just under the skin begin to bulge under this increased pressure and eventually the skin stretches and allows the veins to continue growing. A significant number of the estimated 30 million adults in the United States suffer from this unsightly and often painful presentation of venous insufficiency. Patients with large swollen varicose veins may also complain of heavy, swollen, tired, restless or achy legs. Sitting or standing in the same position, such as during work, can cause worsening of the symptoms throughout the day. Left untreated, the condition generally progresses, with continued enlargement of the veins and thinning of the overlying skin. This can lead to erosion of the overlying skin and varicose vein bleeding or ulcerations.
Venous insufficiency may also manifest itself as leg swelling, skin discoloration, and eventual scarring of the skin and fat to the underlying muscle (stasis dermatitis or lipodermatosclerosis). Lipodermatosclerosis is a significant risk factor in the development of recurrent skin infections and eventual venous ulcerations. Venous ulcers are typically the result of incidental skin trauma which has difficulty healing because of the unhealthy nature of the skin and extra fluid in the tissues which impairs the delivery of oxygen to the wounds. Small tears and simple wounds may fester for months and gradually grow larger. Early evaluation of the venous system is important in establishing the underlying cause of these wounds and in expediting the most effective treatment plan.