Anatomy | Symptoms | Diagnosis | Risk Factors | FAQs
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.
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
Frequently Asked Questions About Vein Disease
Do you ever recommend the use of compression stockings?
Compression stockings are useful during recovery after a procedure, and in preventing blood clots while traveling. For patients who have major vein disease, stockings can provide relief of symptoms by about 50%. They don't treat the underlying cause of disease, but they can provide temporary help in relieving symptoms.
How can I be sure I have a vein problem?
Most people are able to recognize the beginning signs of vein disease on their own. Their legs ache, itch, feel heavy, or cramp. They may also have dilated veins, skin discoloration, swelling, or ulcers. Some people also have spider veins, varicose veins (bulging and blue) or larger veins under the skin which cause them some degree of discomfort.
What happens if I leave my veins untreated?
Vein disease never gets better untreated. It will only stay the same or get worse. If you have beginning signs of vein disease, it is best for you to consult with a vein specialist before complications develop.
Can leg swelling be treated at the Vascular Surgery Vein Program?
Our vascular surgeons are now able to identify patients whose swollen legs may be caused by narrowed veins, scarred veins, or blood clots. By utilizing balloons and stents, these problems can now be treated on an outpatient basis without incisions.
How will my vein disease be diagnosed and treated?
Each patient's vein disease is assessed and an individual plan for treatment is recommended. The diagnosis almost always requires a painless ultrasound exam (Doppler). This exam uses sound waves to "see" and evaluate all the veins in your leg. We offer recommendations for your vein problems that may be non-surgical or a minimally invasive procedure. Whatever the solution to your particular vein problem, it will be the least invasive treatment available. Treatment may involve newly developed thin supportive stockings, ultrasound guided sclerotherapy (vein injections), or same-day outpatient procedures involving minimal incisions using laser energy, microwave energy or light visualization and mini-scopes. The goals of these procedures are to improve cosmetic appearance, resolve symptoms, and minimize recurrence of vein disease with minimal discomfort and time.
What happens to blood flow after the diseased veins are treated?
The abnormal veins that were treated were not functioning correctly prior to treatment. They were the cause of your vein problem. Once the abnormal veins are resolved, blood is re-routed to your normally functioning veins. This further improves your symptoms.
Will treatment of my veins require many days away from work and other daily activities?
No. The expertise of our vein specialists who have pioneered the newest minimally invasive techniques for the treatment of vein disease allows us to provide expert treatment on an outpatient basis. You should be back to your daily routine within a few days.
What if I need the veins that were treated for heart or leg bypass surgery in the future?
Since the treated veins were diseased – weakened and dilated – they could not be used in a bypass procedure. Your other normal veins, however, can be used for heart or leg bypass surgery.
Are all vein procedures covered by insurance?
Most vein procedures are covered by insurance when medically necessary. Of course, any cosmetic treatments of your veins are usually not covered. Our vein specialists and staff can discuss this after initial consultation and evaluation of your specific problem.
Why choose the Vascular Surgery Vein Program?
Our patients benefit from the experience and expertise of our vein specialists, who are among the first in the United States to perform the most minimally invasive techniques. Our program has over 15 years of experience with all minimally invasive vein procedures, having developed and improved many of them. At the Vascular Surgery Vein Program we continue to be among the first in the country to evaluate and perform any new technology. Our patients get the latest techniques first.
In fact, our training sessions draw vascular surgeons from all parts of the United States and abroad who come here to learn our cutting-edge techniques. In addition, our leadership position in this field has already made it possible for our patients to benefit from early clinical trials of many new vein procedures. You are not only treated here, you are treated by the experts who teach others.
If you are in need of help for a vascular condition, we’re here for you. Call us now at (212) 342-3255 or fill out our online form to get started today.
- Aortic Aneurysm
- Carotid Artery Disease
- Chronic Venous Insufficiency (CVI)
- Deep Vein Thrombosis (DVT)
- Minimally Invasive Vein Surgery
- Pelvic Vein Disease
- Peripheral Arterial Disease
- Renal & Mesenteric Arterial Occlusive Disease
- Sclerotherapy for Vein Disease
- Spider Veins
- Thoracic Outlet Syndrome (Vascular)
- Varicose Veins
- Venous Leg Ulcers