Here we explain causes, symptomes, types and diagnosis of vein disorder.
The cause of venous complaints
The cause of venous problems is meanwhile known in much detail. The trigger is a genetic weakness of the veins. To blame for this weakness is that which was such a crucial factor in human development, man’s upright posture. Almost 7000 litres of blood must be pumped against gravity in the veins from the feet to the heart. When venous valves are impaired in the case of venous disease, there is a delay in the transport of the blood back to the heart. This at first manifests itself in heavy legs and in a tendency of the legs to swell and can indicate a wide variety of different health conditions.
In the deep veins:
A prerequisite for efficiently functioning venous valves is a venous wall with sufficient tension. Only if the latter requirement is met can the venous valves close properly. Is this not the case, ie are the venous walls distended, warped or have lost their shape, e.g. in the case of varicose veins, the distance between the two valves grows and they can no longer close properly. Blood can flow back unhindered. One then speaks of venous insufficiency. The venous blood flows as a consequence from the deep leg veins against its natural direction into the superficial veins and causes blood congestion there. The veins must collect the increased volume of blood and expand as a result.
In the superficial veins:
Are only the venous valves of the superficial venous system defective, the deep venous system has to transport more blood than intended. Blood volume increases and the veins distend.
Result: the venous valves can no longer close properly and the blood is only directed back to the heart with delay.
This at first manifests itself in heavy legs and in a tendancy for the legs to swell and can reflect a range of different types of disease, such as varicosis ( varicose veins) and complications following thromboses. The associated discomfort and changes to the skin of the legs are referred to as chronic venous insufficiency (CVI).
These factors favour the development of varicose veins
Impaired blood flow:
- clothing that is too tight and pinches
- crossed legs
- blood volume too high as a result of pregnancy
- sitting or standing for long periods of time
- unhealthy diet, obesity
Relaxed venous wall:
- Hormones (anti-baby pill, hormones against menopause, pregnancy)
Impaired muscle pump:
- wrong shoes (high heels)
- sitting or standing for long periods of time
- congenital weakness of connective tissue and the venous walls
Types of venous disease
A tendency towards venous disease is hereditary, while hormonal influence (pregnancy, the pill), activities that require mainly sitting or standing for long periods of time, obesity and bad shoes demonstrably favour the incidence of vein problems. In Germany more than 50% of the population suffer at least a slight change of the venous system. Early diagnosis and rigorous treatment can alleviate existing complications and protect the patient against serious subsequent damage. However, if they remain untreated, they can cause serious suffering.
In Germany more than 50% of the population suffer at least a slight change of the venous system.
Spider veins are small, red or bluish looking veins, also called micro varicose veins, that lie just below the skin surface. They are a few millimetres or centimetres long, have a diameter of up to 1 millimetre and are often arranged in a fan-shaped structure. Spider veins in contrast to varicose veins are not a disease but usually only an aesthetic-cosmetic problem that can be corrected using a range of treatment options. However, they can also be a warning signal for varicose veins present just below. A visit to a physician can clarify the cause.
A varicose vein (varix) is an extended wildly weaving vein in the skin. It develops when the wall of the veins is distended too much so that the venous valves can no longer close and the blood congests. This results in so-called “phlebostasis”. In comparison with harmless spider veins, varicose veins are a real disease that without the correct treatment may have serious consequences, such as inflammation of the veins, chronically venous insufficiency, vascular occlusion etc. Timely therapy is therefore enormously important.
A thrombosis develops when a blood clot (a thrombus) forms on the vascular wall. This obstructs the veins, the venous valves no longer function and this prevents the blood from flowing back. The result is blood congestion. Most blood clots develop in the deep veins of the leg and pelvis and become apparent through sudden pain in the calves or swelling or a heavy feeling in the legs. A blood clot can develop into fatal pulmonary embolism. That is why it is absolutely essential to visit a physician at the first signs and pursue the matter. Risk factors are sitting for long periods of time (above all while travelling), varicose veins and an increased tendency towards blood clots following an operation or birth of a child.
Pulmonary embolism may occur as a result of a thrombosis. Here the blood clot detaches itself and is released into the blood stream and carried right into the minute branches of blood vessels in the lungs. It may happen that the blood clot is lodged there and disturbs the oxygen supply of the lungs. The result is pulmonary embolism. The lungs can no longer fully perform their original function. In some cases pulmonary embolism can lead to death.
Inflammation of the vein (phlebitis)
A frequent complication of pronounced varicose veins is the inflammation of a venous vessel (phlebitis). It is felt and seen as a painful, bright red and heated strand in the course of the varicose vein often accompanied by swelling. The cause are the blood clots in the superficial vein resulting from the inflammation.
An inflammation of the vein must receive immediate medical treatment, as it could otherwise grow and the blood clots could be embedded in the deep vein system. Untreated varicose veins can develop into chronically venous insufficiency with potential swelling and changes to the skin and even leg ulcers.
Long-lasting venous congestion may lead as a result of the undersupply of the affected tissue to devastating damage of the cells and to tissue necrosis. The result are long lasting open wounds.
Vein diagnostics knows several methods to determine the type and severity of venous disease. The goal of all these measures is to find a therapy that is fine-tuned to the individual. Following methods are common:
In the case of so-called anamnesis the physician establishes during an interview a patient’s medical history with regard to his current ailment. With venous problems the patient is asked about earlier thromboses and inflammation of the veins. The physician further determines any tendency for water to collect in the legs. Women are also asked about pregnancy or whether they take hormonal contraception (the anti-baby pill). And one’s family history is of relevance: family related disease patterns provide information about a possible tendency towards varicose veins and vein problems.
This is then followed by the physician examining more closely the legs in different body positions, the reason being that varicose veins fill up totally when standing and this is not the case when lying down. Also the skin, especially around the ankle is checked very thoroughly. Should edema be suspected (water retention in tissue), the physician will press the swollen leg. If an indentation occurs, which only disappears slowly again, this indicates an edema.
Different kinds of equipment, primarily the Doppler ultra-sonography (a special kind of ultrasonic testing) are available to determine the patient’s medical condition. This method allows for the speed and direction of blood flow to be measured and obstructions or defective venous valves to be detected. By means of duplex and colour duplex sonography an additional ultrasound image of the blood vessels can be generated, which can provide more detailed information about the state and capability of the veins. This method is always used when thrombosis or an inflammation of the veins is suspected, other methods have not provided a clear image or when an operation is planned.
Photoplethysmography (also called light-reflection rheography, in short LRR) can be additionally used to determine the function of the venous system. The skin of the lower leg is irradiated in a specific area with infrared light and measurements are taken to determine how strongly the light is reflected. As the amount of reflected light is dependent on the amount of blood in the veins below, this examination provides evidence of how well the venous system is functioning.
During the examination the patient has to move his foot several times in a certain way as a result of which the veins under observation gradually empty. Then it is measured how long it takes till the veins are filled with blood again. Should it take longer than 25 seconds, everything is fine. Should the veins fill more quickly, this indicates venous insufficiency because the blood flows back through the damaged venous valves against the normal direction of blood flow.
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