Varicose Veins and Venous Disease
(A guide for patients)
Dr Dion Davidson BSC MD FRCSC FACS
Abnormal leg veins are more common than you may think; they are thought to affect a third of the adult population. These range from those tiny little “spider veins” (technically called telangiectasias) to huge bulging varicose veins and everything in between. Any of these can be painful, even the little ones. For a significant number of people, the underlying problem can even lead to leg ulcers which also can be very painful and can be very difficult to heal, especially if neglected. Surprisingly, one person might have big varicosities or even ulceration that is not painful or otherwise symptomatic at all while little spider veins might be painful for someone else. Many people are also bothered by the appearance.
All of these abnormalities are due to chronic venous disease. This is a disease process that is poorly understood, even by many doctors. It is not often taught well (or at all) in medical schools. Misconceptions about this disease are common, including that it is only a cosmetic problem, that not much can be done even if it is painful and that treatments are only available in expensive private clinics.
It is very important to set the record straight about venous disease and varicose veins:
- This is a serious medical problem affecting large numbers of people.
- While cosmetic appearance is the main concern for some patients, for many others venous disease can be very painful and debilitating.
- There are very effective treatments available for the whole spectrum of the disease. Although there are legitimate private sector options, advice and treatment is available and covered financially by public health care, especially for patients with pain and other symptoms.
- Dealing effectively with the disease can often require some thoughtful consideration and a bit of time and effort on the part of healthcare providers.
As a vascular surgeon, I talk to patients about chronic venous insufficiency as a disease. They’re often surprised at this approach; for years they were told to ignore the problem and were dismissed as being “vain” (pardon the pun). However, thinking about the problem as a disease is critical to improving quality of life for these patients.
Simply put, arteries take blood with oxygen and nutrients from the heart to the body’s tissues (for example, muscle, brain) and veins take it back to the heart once the tissue has used the oxygen and other substances it needs. So, leg veins are generally supposed to conduct blood up to the heart while we are living most of our lives sitting or standing upright. A lot of the initial force that gets the venous blood moving up is contraction of leg muscles. Then, valves inside the veins keep the blood moving toward the heart. Of course, gravity works against that flow of blood in the legs much of the time.
For a variety of reasons, some of which have still not been well described by scientific study, some people have weaker vein walls than others. Often, all that we can tell is that the patient is “unlucky”, basically that their tendency toward weaker vein tissue must just be congenital; indeed, the disease commonly runs in families. Less commonly, people can have poorly functioning veins because of past blood clots.
The weaker vein walls lead to dysfunction of the valves; the blood begins to reflux backward, back down the leg rather than up toward the heart. In what becomes a vicious cycle, this leads to more venous blood pooling in the legs, which stretches and weakens the veins more, leading to worsening valve function. Eventually, venous pressure increases to the point that diseased veins start becoming noticeable within the skin and deeper tissue and pain and swelling increasingly become bothersome. In the end stages, venous pressure in skin and deeper tissue increases enough to interfere with the exchange of oxygen and nutrients and skin becomes discolored and unhealthy to the point of breakdown and ulceration.
In part two of this article I’ll review the imaging tests we use to get to the bottom of venous disease and the treatments that can help so much …