Vein Disease

Anatomy of the Veins

Arteries bring oxygen-rich blood away from the heart to the extremities, and can be thought of as a tube or hose. Veins, unlike arteries, have one-way valves (like a check-valve or one way door) that help to direct oxygen-depleted blood up the legs towards the heart. In normal veins, the one-way valves close so that blood cannot leak back down the legs. In people with vein disease, the one-way valves don't close all the way. Blood then leaks back down the veins (venous reflux) and collects in the legs, causing the veins to enlarge and causing symptoms or complications.

Illustration shows superficial, perforator, and deep veins.There are three types of veins in the leg:

  • Superficial veins: visible veins within the skin or just below the skin which may include spider veins, varicose veins, and reticular veins.
  • Deep veins: the main veins which are located within the leg muscles or in the pelvis and abdomen.
  • Perforator veins: connect the superficial and deep veins.

Vein disease may affect any of these three types of vein. Symptoms may be more severe and complications are more likely to develop when disease occurs within more than one type.

Symptoms of Vein Disease

Many people have visibly abnormal veins (spider veins or bulging varicose veins). Symptoms may include: pain, aching, throbbing, itching, cramping, swelling, or heaviness. These symptoms usually get worse as the day progresses or when standing or sitting for prolonged periods. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower leg. Complications of more advanced vein disease may include darkened or damaged skin around the ankles, open skin ulcers, phlebitis (inflammation of a vein caused by a clot), and blood clots that may travel to the heart or lungs.

Vein disorders are not always visible. Diagnostic techniques, such as non-invasive ultrasound, are the main tools used in determining the cause and severity of the problem.

Diagnosing Vein Disease

Almost all vein problems (98%) can be diagnosed with an ultrasound (doppler) study. This completely non-invasive exam uses sound waves to view and evaluate the function of all the veins in your legs, including the presence of any clots. This is performed in our IACVL* accredited vascular laboratory and takes about twenty minutes. No pain is involved and there is no risk.

All the veins in the legs can be imaged during ultrasound, including skin veins and the deeper veins within the muscles. The test is about 99% accurate when performed by an experienced vascular technologist or phlebologist (vein doctor). An ultrasound study reveals exactly how the veins are working and indicates the likelihood that a person's vein disease may progress. In experienced hands, the ultrasound test is almost 100% effective in identifying life-threatening blood clots.

If the phlebologist (vein specialist) is concerned that the veins in the pelvis or abdomen are abnormal, then a CT scan orMRImay be necessary. In a small percentage of patients, a venogram is done through a needle stick in the thigh and dye is injected into the veins while pictures are taken.

In general, almost all vein issues can be diagnosed with the above non-invasive or minimally invasive technologies. These diagnostic studies, along with our minimally invasive therapeutic techniques, allow almost all of our patient to return to normal activities within one to two days.

Intersocietal Commission for the Accreditation of Vascular Laboratories

Risk Factors for Vein Disease

There are multiple risk factors for vein disease and its complications:

Inherited Factors: The most significant cause of vein disease is family history. If one parent has had vein problems, one's risk of developing vein disease is about 33%. If both parents have vein disease, the risk increases to greater than 90%.

Hormonal Factors: Circulating hormones that relax the smooth muscle of the vein wall can play a significant role in causing vein disorders. Women have high levels of one such hormone, progesterone, which increases their risk compared to men of developing venous disease. Pregnancies, hormone replacement therapy, and the use of female oral contraceptives further increase this risk among women. This is the reason approximately 75% of all patients with vein disease are women and 25% are men.

In addition to inherited and hormonal factors, other causes of vein disease include:

  • Advancing age
  • Being overweight or obese
  • Prolonged standing
  • Prolonged sitting with legs crossed
  • Wearing tight undergarments or clothes
  • A personal or family history of blood clots
  • Injury to the veins
  • Conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery, or heart failure