Varicose Veins

Varicose veins are surface-level veins which have become dilated and twisted. Varicose veins develop when there is increased pressure or stretching of the veins, keeping the valves in the veins from functioning well. While they certainly look unattractive, they are much more than a cosmetic concern. They are often symptomatic, causing heaviness, fatigue, aching, burning, throbbing, itching, and cramping. These symptoms are typically worse with prolonged sitting or standing and are relieved by elevating the legs, walking, or wearing compression stockings. The severity of symptoms, ironically, does not correlate with the size or number of varicose veins present. Vein disorders are not always visible from the surface, so a careful evaluation by a vein specialist is needed to determine the extent of the problem.

In addition to the symptoms they cause, varicose veins increase the risk of more serious complications including deep and superficial blood clots and the skin damage associated with chronic venous insufficiency.

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Varicose Veins Background

Veins are the blood vessels that are designed to take the blood back to the heart after it has been out in circulation. In the legs, there are deep veins down inside the muscle layer. These are the most important for your circulation. In the soft tissue just below the skin are some main superficial veins called the Saphenous veins. The Great Saphenous Vein (GSV) runs up the inside of the leg from the ankle to the groin. The Short Saphenous Vein (SSV) runs up the back of the calf from the outside of the ankle behind the knee. Its anatomy is more variable, but in many people it ends somewhere the knee crease. There are short perforator veins which directly connect the deep and superficial veins throughout the leg as well.

The deep and Saphenous veins are designed with valves which open to allow the blood to move up the veins and close to keep it from flowing back toward the feet. When these valves are working normally, the blood flows from the superficial veins toward the deep veins, from the feet toward the head, and there is never more than a small column of blood putting pressure on any one segment of the vein or its branches. In a lot of people, however, these valves become damaged or wear out over time. That allows a much longer column of blood to pool under higher pressure in the vein. The longer the legs are dependent, the more blood pools and the higher the pressure can become. That higher volume/higher pressure in the veins is transmitted to the surface branches that are trying to drain into those veins, which causes them to swell up and become the varicose and spider veins that are visible on the skin surface.