VASCULAR SOLUTIONS - Vascular and Endovascular Surgeons Treating Peripheral Vascular Disease in Cleveland, Ohio

Vascular Solutions

Varicose Veins: Education and Options - Vein Stripping, Obliteration, Sclerotherapy

Venous Diseases:

General Information

The two main systems for blood drainage in the lower extremities are the superficial venous system and the deep system. The superficial venous system is comprised of the greater and lesser saphenous. Veins in both the superficial and deep system have valves. The valves function to provide primarily one way directional flow - toward the heart. If the valves fail to function properly, the blood will move in a bidirectional pattern producing increased pressure in the lower leg. In the case of veins close to the skin it results in a bulging, twisted appearance commonly known as varicose veins. The superficial and deep system veins communicate. When either the superficial, deep system or both have valvular dysfunction or incompetence, pathologic manifestations occur that are commonly known as venous disease. These conditions can result in chronic wounds of the lower leg that are often difficult to heal. Factors that may contribute to these conditions include pregnancy, genetics, excessive weight, jobs requiring prolonged standing in one position without moving. The precise cause of varicose veins is probably multifactorial. Varicose veins are a disease of Western civilizations. Vein problems are observed more frequently in females and is thought to have some relationship to estrogens. More than half of adult men and two thirds of adult woman have physically identified varicosities.

Pathophysiology

All of the blood course through veins and eventually drain into the inferior and superior vena cava that then feeds into the heart. The venous system does not have high pressures as does the arterial system. It also does not have a central pump like the heart which drives the blood in a single direction. Nor does it have a muscular wall as does most arteries that stores part of the energy derived from a pulse wave to ensure unidirectional flow when the heart is refilling. Veins refill the heart by a passive drainage, using a low pressure - lazy river flow mechanism. In the case of the lower extremities, gravity must be overcome. Muscular contractions in the calf help provide a "small pump" action but if the valves are not functioning then blood flow becomes chaotic and bidirectional. The heart, located in the chest, is over 3 1/2 feet from the ankles. A column of blood in the inferior vena cava, because of gravity, has the potential to produce significant pressure, if unchecked, at the level of the ankles. This pressure results in an inflammatory reaction which alters the skin and surrounding tissues. Red cell breakdown in the surrounding tissues results in hemosiderin deposits that creates the brown, tattoo appearance of the venous stasis patient. Inflammatory mediated cells attempt to clear the hemosiderin deposits and die in the process, releasing toxic agents that further inflame and destroy health surrounding tissues and skin. Skin breakdown also leads to scarring which has a weaker structure and has a higher enhanced risk for future skin breakdown.

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