A common misconception about varicose veins is that they only happen in women. In fact, in the population that suffers from varicose veins, nearly 40% are men. Risk factors for varicose veins include genetic predisposition (if your mother or father had them), prolonged standing from work or lifestyle, increased height, congenital valvular dysfunction, obesity, and multiple pregnancies. They can also result from a history of a deep venous thrombosis or DVT. Genetic predisposition probably plays the most significant role. One study showed that if both your mother and father had varicose veins, there is a 90% chance that you also will have them. To understand how varicose veins form, it is important to understand the anatomy of a healthy vein and an unhealthy vein. Veins have valves that help the blood flow ONE WAY back up to your heart. When these valves become diseased and the veins become larger, the blood that is only supposed to go back up to your heart starts pooling in your feet and legs.
There are three main types of veins in your legs: Deep Veins: These carry between 97% to 99% of the blood back up to your heart from your legs. They are the most important vein system in your legs. Perforator Veins: These veins are bridges between the superficial veins and the deep veins. Frequently these are the culprits behind ulcers of the lower leg. Superficial Veins: These are the closest to the skin but are not visible. There are two main veins of this system called the Great Saphenous Vein and the Short Saphenous Vein. However, this system has the greatest variation and can have accessory or additional veins also. The picture below describes the anatomy of the superficial and the deep system. The picture on the right shows the anatomy of the perforator vein system.
Varicose veins can lead to discomfort, skin changes, work absences, and significant medical and emotional disability as reflected by decreased scores on health-related quality-of-life surveys. Patients with varicose veins have an increased number of inflammatory and clotting markers.
There are other more severe complications that can be associated with varicose veins which include ulcerations and clots in your deep veins. These clots can then travel to your lungs and they are called pulmonary embolisms.
A recent study showed that among adults diagnosed with varicose veins, there was a significantly increased association of DVT (Deep Vein Thrombosis). The findings also noted a higher incidence of PE (Pulmonary Embolism).
Another risk of varicose vein disease is the formation of venous ulcers. Venous ulcers form on an area that has continuous trauma from blood that is sitting in one place without much movement. Think of it as how your hands look after you wash dishes in a sink with still water. Imagine doing that for years without taking a break… eventually your skin starts to break down. When this process happens on your legs, an ulcer will form. Ulcers are very difficult to treat with physical therapy or compression therapy because the underlying disease is not treated. The only way to treat the underlying disease is to close the diseased vein underneath the ulcer. The following pictures show before and after laser ablation treatments and grafting of venous ulcers.
Venous disease does not simply improve by itself. You can control for symptoms with the use of compression stockings and lifestyle changes such as weight loss and exercise.
Available studies show that although stockings improve symptoms temporarily they DO NOT treat the underlying disease. The disease most commonly will continue to progress. Adherence to stockings is also very difficult given the discomfort of wearing them for several hours and if fitting is problematic. Compression therapy is often a Band-Aid for the problem.