Varicose veins
General information
Varicose veins are very common affecting at least 10-15%
of the adult population in the UK. This condition can be
embarrassing and painful and if untreated can lead to leg
swelling, pigmentation of the skin of the lower leg and ulcers.
Venous ulceration affects 10% of people with varicose veins
and can be difficult to heal.
Veins are the vascular structures which carry blood back
towards the heart (arteries carry blood away from the heart).
There are two systems of veins in the leg:
The deep system carries the majority of the blood and, as
the name suggests, lies deep within the muscles and contains blood
under high pressure generated by the contraction of your thigh and
calf muscles. - The superficial system lies just underneath the skin and is designed to carry blood under low pressure. The superficial veins join the deep veins at two main points, in the groin and behind the knee. At each point, valves prevent high pressure blood from the deep system entering the superficial system.
If the valves become leaky the high pressure blood enters the superficial veins and causes them to become dilated and visible - creating varicose veins.
Instead of all the blood from the legs returning to the
heart, a proportion of blood refluxes back down the superficial
veins impairing the venous circulation of the leg and giving
rise to the symptoms of aching, swelling and night cramps.
If the venous circulation is impaired for a long time the
delivery of oxygen to the skin around the ankle is decreased
and toxins accumulate. Over the years this causes a thickening
and pigmentation of the skin which is similar in appearance
to eczema - venous eczema. Eventually, the
skin affected by venous eczema breaks down and an ulcer develops
- a venous ulcer.
Fortunately, recent advances in the assessment of varicose
veins mean that the underlying causes of the many various
conditions which come under the heading of varicose veins
are much better understood and the correct treatment can
be applied.
LONG SAPHENOUS VARICOSE VEINS
- The most common form of varicose veins, originating from a leaky valve in the groin where the superficial long saphenous vein joins the deep femoral vein.
- Blood refluxes the wrong way down the long saphenous vein which runs down the inside of the thigh, around the knee and spreads out over the inside of the calf and ankle.
- Treatment requires the thigh vein to be treated even though there may be no visible veins in the thigh. This is because the vein is often quite deep within the tissues.
- The veins become much closer to the skin in the calf and that is where most varicose veins are visible.
SHORT SAPHENOUS VARICOSE VEINS
- Short saphenous varicose veins originate from a leaky valve behind the knee and run down the back of the calf.
- They can also originate from an abnormal vein in the calf called the gastrocnemius vein which is visible on Duplex ultrasound.
Long and short saphenous varicose veins often occur together and there are many variations of varicose veins. Unless these variations are recognised and dealt with, treatment will not be successful.
