Varicose Veins

(Venous Disease of the Lower Extremity)

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Have varicose and spider veins made you self conscious because of the appearance of your legs? Do your legs feel tired and achy? Have you modified your life style because of this problem?

What is the single most important reason why you have venous disease?

The inherited anatomical characteristics of your vessel's connective tissue and their valves set you up to have venous disease. If you are a female and become pregnant your hormones immediately begin to change and your connective tissue becomes more elastic and stretchable. When the fetus is as small as your little finger tip and if you are genetically programmed to have this problem you are already seeing the occurrence of varicose veins. Occupations that require standing for hours also contribute to the formation of the varicosities.

What is going on that causes this to occur?

You first need to have some understanding of the venous anatomy of the legs. Anatomists have divided the venous system into a superficial and deep system. The superficial system is the veins that are outside the connective tissue (fascia) that covers your leg muscles. Conversely the veins that are covered by the fascia are the deep system. Eventually all of the blood in the superficial system is supposed to enter the deep system. There are veins that drain the superficial systems blood into the deep system. These veins are call perforating veins because they perforate the connective tissue that encloses the muscles. They are commonly called perforators. If every thing is working correctly these are one way valves that open only when the blood is traveling toward the heart or from the superficial system to the deep system in the case of the perforating vessels. Varicosities are caused by increased pressure in the venous system as the result of failure of the valves. When you walk the calf muscles contract and push the blood toward the heart. This is called the calf pump. If the deep system's valves are leaking or the perforate vein's valves are leaking, this pumping of blood by the calf muscles is compromised or even lost in some cases. The higher up the leg that you have mal-functioning (leaking) valves the higher the pressure is at lower points down the leg.

How do you treat this condition?

You can start by wearing 30 to 40 mm; graduated compression hose. Non-invasive compression sclerotherapy is also effective. The results vary with the experience of the practioner. There are devices to destroy the veins with radiofrequency energy, laser energy, ligation and division of various veins, vein stripping etc.

Like all medical conditions you should first make an accurate diagnosis. In experienced hands a great deal of information can be obtained by using a simple hand held doppler. A duplex ultra sound is also effective in determining pathological reversal in venous blood flow patterns.

An air plethysmographic study gives anatomical and physiological information that rivals invasive radiologic studies and in some physiological instances exceeds them. It can evaluate on the patient examined the value of compression stockings in preventing progression of the pathology, if the deep as well as the superficial venous systems have reflux, what the patients chances are of developing venous stasis ulcers as they age, the efficiency of the calf pump, etc.

Call for your appointment and let us help you understand your venous pathology and what your treatment options are.