What is the role of the veins in the circulation?
The veins constitute the return half of the circulation. When the heart beats it expresses blood that flows through blood vessels (called “arteries”) to deliver “new” blood with fresh oxygen and nutriments to every cell in the body. The arterial blood flows through capillaries in the tissues of the body where it exchanges the oxygen and nutriments inside the cells for “old” blood which has collected the products of metabolism. This blood is collected by the veins from every cell in the body to be returned to the heart and other organs where it is again re-freshed with oxygen and nutriments.
What is a healthy vein valve?
The valves are strong but delicate structures inside the veins of the extremities whose function is to direct the flow of blood like a policeman directs traffic. They cause the blood to flow from every cell in the body by a direct route back to the heart and central organs. In the legs the valves direct the blood from the foot to the heart by closing the blood flow behind the flowing stream which prevents reverse flow in any given vein, even against gravity. In general, they direct flow from the skin and outer parts of the body to the core where the heart is located. If the valves fail to work properly in the leg veins when the individual is standing and sitting with the legs dependent, the blood flows back and forth in two directions, and the system no longer functions properly. This leads to congestion in the legs with heaviness, swelling, and even inflammation over time.
What is the cause of spider veins?
Spider veins are located in the skin itself. Other veins are under the skin. The cause of spider veins is unknown. They are so common that nearly everyone knows someone in the family who has had them. They are more prevalent in women but occur in men as well. They can appear locally after trauma or after superficial surgery, even after vein surgery. We do not know how to prevent them. The advice to avoid crossing the legs or wearing constricting clothing or garters to prevent them has no established basis. The hope that support stockings and dietary supplements are of help is unsubstantiated.
What are varicose veins?
Varicose veins are dilated tortuous (twisting) veins with weakened walls and valves that no longer close when they should. They represent the first stage of clinical “Primary Vein Disease” (PVD), and are known as ‘varicose veins’ in common terms. They occur mainly in the lower extremities and are important for the health of the skin and superficial tissues.
They first appear as bulges under the skin of the erect individual and disappear when the limb is elevated above the heart, and are mainly of cosmetic importance.
As time passes the local blue bulge often progresses to become a line of dilated veins that protrudes under the skin and creates a chain of bluish bubbles on the inside of the lower thigh or calf. These changes can develop over a period that ranges anywhere from 2 years to 30 or 40 years. As these changes occur the person may experience variable symptoms like heaviness, itching, tingling, burning, night cramps, and even swelling of the leg. In this stage of Primary Vein Disease the varicose veins may cause a significant decrease in the quality of life for many persons, perhaps up to 1/4 of the adult population to a variable degree.
What is a venous ulcer?
A chronic venous ulcer (non-healing sore) in the skin refers to a site on the lower leg or ankle where the normal skin covering has been destroyed by an inflammatory process and the (subcutaneous) tissue under the skin shows through. In the leg between the knee and the foot the most common cause of these ulcers is leaking venous valves or obstructed central veins causing high pressure and abnormal circulation in the tiny vessels of the skin. Ulcers represent a late stage of lower extremity vein disease (including both varicose veins and blood clots) when the abnormal circulation from long standing reflux or blockage in the veins causes the skin to become thickened and inflamed, and it actually breaks down into an open sore.
What are the symptoms of a blood clot?
Blood clots (or phlebitis) can occur in any vein of the leg. Superficial phlebitis may present as red tender lines on the surface of the legs while deep phlebitis can develop silently and grow extensively in the deep veins of the leg before being discovered. Phlebitis is suspected by the physician when there is swelling or pain in just one leg that is not explainable by other causes such as an injury or other event. The diagnosis of phlebitis requires an ultrasound examination for positive identification. This should be done for any extremity in which unexplainable symptoms of swelling or pain occurs and does not respond to usual measures of rest and relaxation within a day or two.
Superficial phlebitis is easily seen as an area of inflammation that is tender and red and swollen, and feels usually like an oblong lump near the skin. It often occurs in legs that have varicose veins. This kind of phlebitis is easier to diagnose and less serious than the phlebitis that develops in the deep veins where the blood clot has a high tendency to extend up and down the leg with minimal symptoms and can give rise to pieces that break off and travel to the lungs.
Who is at risk for blood clots?
Blood clots are more likely to occur in older persons, patients at bed rest, individuals with cancer or with surgical procedures especially surgery on the hip or knee. They have also been identified in people who travel long air flights. Blood clots are potentially dangerous if there is a small clot that has begun in the leg before the flight begins. We advise persons with unexplained leg pain or swelling to check with their physician before taking a long air flight because an evolving leg blood clot can become dangerous during flight — and this can be prevented by an ultrasound test that leads to diagnosis and treatment of an active blood clot before the flight.
What are lymphatics and lymph nodes?
Lymphatics are tiny vessels with tiny valves (like veins) that collect lymph fluid throughout the body and return it to the large central veins near the heart. The lymph is formed by body fluid outside of the blood vessels and it is collected by the very small lymphatic vessels that pass through filtering sites called lymph nodes along the way back to the heart. The lymphatics are very important because they return literally quarts of water each day from the lower legs to the heart, and if they lose their normal function marked swelling will occur.
What is Lymphedema?
Lymphedema refers to the swelling in an extremity that occurs from failure of the lymphatics to drain the lymph as it is formed in the extremity.
How will treatment for my venous disorder impact my daily activity?
Venous disorders are frequently a cause of daily discomfort in their various stages of development as described above. In the earlier stages of PVD the elimination of certain patterns of vein dilation and valve dysfunction can relieve leg discomfort and fatigue dramatically while it also improves cosmetically unattractive appearance. People often feel healthier and even younger when their legs are treated.
Fortunately, progression of venous disease to advanced stages only occurs in a minority of cases, and it develops slowly (over decades) in most instances. When it does progress to later stages the vein dysfunction often becomes complicated by inflammation and progresses through swelling to permanent discoloration, and even further to thick scarred skin and subcutaneous tissue with danger of, or actual occurrence of ulceration.
Aggressive treatment is necessary in later stages to preserve a normal lifestyle. Scarring and tissue changes can become non-reversible, and a small percentage of individuals are unable to lead a normal life because their leg will not tolerate being dependent due to swelling and ulceration of the tissues.
Treatment is individualized in the Kistner Vein Clinic by directing treatment to the most appropriate effective method for the diagnosed problem. The office treatments are performed on a walk-in and walk-out basis. There is expectation of near immediate return to customary activity and minimal if any loss of work time for most cases.