About Venous Disease

Lower Extremity Venous Anatomy

Arteries convey oxygen-rich blood from the heart to the feet. Veins return depleted blood from the feet back to the heart. The lower extremity venous anatomy is divided into three systems: the deep venous system, superficial venous system, and the perforator veins.

The deep system consists of the common femoral vein, the femoral vein (formerly known as the superficial femoral vein), the deep femoral vein, the popliteal vein and the deep veins of the calf. The deep veins are located near the center of the legs and are surrounded by muscles and fascia. Deep veins are well-supported and naturally resistant to dilation and valvular failure. Most vein patients therefore have normal deep veins. This is fortunate because the deep venous system is responsible for 90% of lower extremity blood return.

The main superficial veins are the great saphenous and small saphenous veins. Accessory saphenous veins, the intersaphenous vein (a.k.a. Vein of Giacomini), and various tributaries drain into the great saphenous and small saphenous veins. The superficial veins reside just below the skin and are not effectively supported by muscle or fascia. They are therefore prone to dilation and valvular failure. Most venous insufficiency occurs in the superficial venous system.

Each leg has over 150 perforator veins that connect the deep and superficial venous systems. Perforator veins contain valves that normally direct blood from the superficial veins to the deep veins. If these valves fail, high-pressure deep venous blood refluxes into the superficial veins, causing severe superficial venous hypertension. Perforator vein disease is a common cause of superficial venous insufficiency and venous stasis ulcers.

Calf Muscle Pump

Arteries deliver nutrients and oxygen from the heart to the extremities at relatively high blood pressures (usually 120/80 mmhg). Only a little of this pressure is left after the blood filters through the capillaries. Veins convey cellular waste from the extremities back to the heart at relatively low blood pressures (10-15 mmhg when lying down).

Gravitational force on a column of blood creates a downward pressure known as "hydrostatic pressure". When standing upright hydrostatic pressure assists arterial flow to the feet, but impedes venous return from the feet back to the heart.

The low venous blood pressure pushing upward cannot overcome the downward hydrostatic pressure without assistance. This assistance comes in two forms:

Delicate venous valves occur at regular intervals within all leg veins that force the blood to flow only upwards in the deep and superficial veins and inwards through the perforator veins
The deep leg veins run within the calf muscle, which is sheathed in layers of fibrous "fascia" Each time the calf muscle contracts, it squeezes the deep veins, emptying these veins of blood. Because of the one-way venous valves, the blood can only go "up" or back toward the heart. Thus, the calf muscles and the veins within them form a calf muscle pump. The calf muscle pump provides upward propulsion to overcome the downward hydrostatic pressure and send venous blood back to the heart.

Calf muscle pump problems generally begin when the delicate valves in the deep veins malfunction. These faulty valves allow blood to reflux and pool in the veins, resulting in venous insufficiency. There are no good procedures to cure this problem. Fortunately, the calf muscle pump is extremely durable and resistant to malfunction. Fewer than 10% of our patients have calf muscle pump dysfunction.

The calf pump is idle when you stand still or sit with your legs in a dependent position. In these positions, gravity causes blood to pool in the lower legs. This pooling of blood makes your legs feel tired, heavy and achy. Prolonged standing still or sitting with legs dependant are therefore bad for your veins. Exercise and leg elevation are good for your veins because they prevent pooling of blood.

Venous Insufficiency

All leg veins have numerous one-way valves that prevent blood from flowing backwards or refluxing. Leg vein problems generally begin when these delicate valves become weak and malfunction. Faulty valves allow blood to reflux and pool in the veins, leading to increased pressure within the veins. The increased pressure is transmitted to the tributary veins, the capillaries, and the tissues drained by the diseased vein. This condition is the most common form of venous disease and is referred to as venous insufficiency.

Venous insufficiency can be seen in the deep venous system (usually as a result of deep venous thrombosis), or in the superficial venous system (usually from dilation of the veins). Venous Insufficiency is typically progressive. In addition to causing varicose veins, it can lead to pain, swelling, restless legs syndrome, brown pigmentation, bleeding, and non-healing ulcer formation. It is important to seek medical treatment early in order to stop the natural progression of this disease and reduce symptoms to achieve the best possible functional and cosmetic results.

Symptoms of Venous Insufficiency

Aching / Throbbing Pain
Heavy / Tired Legs
Soreness
Chronic Edema / Swelling
Itching
Numbness
Night Cramps
Restless Legs syndrome

Types of Diseased Veins

Spider Veins

Spider veins or telangiectasias are tiny blood vessels just beneath the skin surface. They are filled with blood, which makes them visible through the skin. They are red, blue, or purple in color and can vary from a single dot or line to dense mats or clusters.

Contrary to what many physicians are taught, spider veins can cause many of the same symptoms of much larger varicose veins, such as itching or burning, heaviness, and fatigue in the legs. Although they may be symptomatic, spider veins are considered a cosmetic problem rather than medical condition. They do not lead to serious complications. The primary concern with spider veins is their unsightly, embarrassing appearance that may interfere with normal physical or social activities.

Spider veins are often caused by underlying venous insufficiency and can be an indication of diseased large vessels underneath. Dr Hayes may use an ultrasound or vein lite to search for any larger diseased veins that may be causing your spider veins. If venous insufficiency is diagnosed, it needs to be treated first; or spider vein treatment will be ineffective.

The tendency to develop spider veins is largely hereditary, and there is not much you can do to prevent them. Support hose and exercise are helpful for symptoms, but the veins keep growing. Pregnancy and hormonal variations hasten their appearance.

Reticular Veins

Reticular veins are darker veins that form bluish networks that criss-cross over the thighs and lower legs. They are considered a cosmetic difficulty rather than a medical condition. They are larger than spider veins and "feed" spider veins. Ignoring them when treating spider veins can lead to less than optimal results.

Varicose Veins

Varicose Veins (often misspelled as Vericose) are permanently enlarged veins located beneath the skin. They become dilated and tortuous in response to abnormally high pressures seen in venous insufficiency. They are typically blue or purple, measure 3-8 mm in diameter, and have a twisted, ropy appearance. They affect an estimated 10% to 60% of the adult population, most of which are women.

Varicose veins are caused by superficial venous insufficiency. As described above, superficial venous insufficiency is due to faulty one-way valves that do not close properly and allow blood to leak back with gravity and pool in the saphenous veins and their tributaries. This pooling leads to abnormally high venous pressures within malfunctioning veins which causes them to distend and balloon out, thus becoming varicosities.

One of the biggest contributing factors in the development of varicose veins is heredity or family history. Other risk factors include prolonged standing or sitting, pregnancy, hormonal influences, and obesity. The incidence increases with age.

Varicose veins are irreversibly damaged and do not assist in blood circulation (in fact they actually impair blood return to the heart). The body will not miss them when they are removed, and they are not suitable for use during heart bypass procedures.

	Contact Us

Home Dr. Hayes Our Clinic Location Forms About Venous Disease Venous Anatomy Calf Muscle Pump Venous Insufficiency Diagnosis Treatment Options FAQ's Vein Myths Restless Legs Syndrome History of RLS Current RLS Theories RLS Research Links
About Venous Disease Lower Extremity Venous Anatomy Arteries convey oxygen-rich blood from the heart to the feet. Veins return depleted blood from the feet back to the heart. The lower extremity venous anatomy is divided into three systems: the deep venous system, superficial venous system, and the perforator veins. The deep system consists of the common femoral vein, the femoral vein (formerly known as the superficial femoral vein), the deep femoral vein, the popliteal vein and the deep veins of the calf. The deep veins are located near the center of the legs and are surrounded by muscles and fascia. Deep veins are well-supported and naturally resistant to dilation and valvular failure. Most vein patients therefore have normal deep veins. This is fortunate because the deep venous system is responsible for 90% of lower extremity blood return. The main superficial veins are the great saphenous and small saphenous veins. Accessory saphenous veins, the intersaphenous vein (a.k.a. Vein of Giacomini), and various tributaries drain into the great saphenous and small saphenous veins. The superficial veins reside just below the skin and are not effectively supported by muscle or fascia. They are therefore prone to dilation and valvular failure. Most venous insufficiency occurs in the superficial venous system. Each leg has over 150 perforator veins that connect the deep and superficial venous systems. Perforator veins contain valves that normally direct blood from the superficial veins to the deep veins. If these valves fail, high-pressure deep venous blood refluxes into the superficial veins, causing severe superficial venous hypertension. Perforator vein disease is a common cause of superficial venous insufficiency and venous stasis ulcers. Calf Muscle Pump Arteries deliver nutrients and oxygen from the heart to the extremities at relatively high blood pressures (usually 120/80 mmhg). Only a little of this pressure is left after the blood filters through the capillaries. Veins convey cellular waste from the extremities back to the heart at relatively low blood pressures (10-15 mmhg when lying down). Gravitational force on a column of blood creates a downward pressure known as "hydrostatic pressure". When standing upright hydrostatic pressure assists arterial flow to the feet, but impedes venous return from the feet back to the heart. The low venous blood pressure pushing upward cannot overcome the downward hydrostatic pressure without assistance. This assistance comes in two forms: Delicate venous valves occur at regular intervals within all leg veins that force the blood to flow only upwards in the deep and superficial veins and inwards through the perforator veins The deep leg veins run within the calf muscle, which is sheathed in layers of fibrous "fascia" Each time the calf muscle contracts, it squeezes the deep veins, emptying these veins of blood. Because of the one-way venous valves, the blood can only go "up" or back toward the heart. Thus, the calf muscles and the veins within them form a calf muscle pump. The calf muscle pump provides upward propulsion to overcome the downward hydrostatic pressure and send venous blood back to the heart. Calf muscle pump problems generally begin when the delicate valves in the deep veins malfunction. These faulty valves allow blood to reflux and pool in the veins, resulting in venous insufficiency. There are no good procedures to cure this problem. Fortunately, the calf muscle pump is extremely durable and resistant to malfunction. Fewer than 10% of our patients have calf muscle pump dysfunction. The calf pump is idle when you stand still or sit with your legs in a dependent position. In these positions, gravity causes blood to pool in the lower legs. This pooling of blood makes your legs feel tired, heavy and achy. Prolonged standing still or sitting with legs dependant are therefore bad for your veins. Exercise and leg elevation are good for your veins because they prevent pooling of blood. Venous Insufficiency All leg veins have numerous one-way valves that prevent blood from flowing backwards or refluxing. Leg vein problems generally begin when these delicate valves become weak and malfunction. Faulty valves allow blood to reflux and pool in the veins, leading to increased pressure within the veins. The increased pressure is transmitted to the tributary veins, the capillaries, and the tissues drained by the diseased vein. This condition is the most common form of venous disease and is referred to as venous insufficiency. Venous insufficiency can be seen in the deep venous system (usually as a result of deep venous thrombosis), or in the superficial venous system (usually from dilation of the veins). Venous Insufficiency is typically progressive. In addition to causing varicose veins, it can lead to pain, swelling, restless legs syndrome, brown pigmentation, bleeding, and non-healing ulcer formation. It is important to seek medical treatment early in order to stop the natural progression of this disease and reduce symptoms to achieve the best possible functional and cosmetic results. Symptoms of Venous Insufficiency Aching / Throbbing Pain Heavy / Tired Legs Soreness Chronic Edema / Swelling Itching Numbness Night Cramps Restless Legs syndrome Types of Diseased Veins Spider Veins Spider veins or telangiectasias are tiny blood vessels just beneath the skin surface. They are filled with blood, which makes them visible through the skin. They are red, blue, or purple in color and can vary from a single dot or line to dense mats or clusters. Contrary to what many physicians are taught, spider veins can cause many of the same symptoms of much larger varicose veins, such as itching or burning, heaviness, and fatigue in the legs. Although they may be symptomatic, spider veins are considered a cosmetic problem rather than medical condition. They do not lead to serious complications. The primary concern with spider veins is their unsightly, embarrassing appearance that may interfere with normal physical or social activities. Spider veins are often caused by underlying venous insufficiency and can be an indication of diseased large vessels underneath. Dr Hayes may use an ultrasound or vein lite to search for any larger diseased veins that may be causing your spider veins. If venous insufficiency is diagnosed, it needs to be treated first; or spider vein treatment will be ineffective. The tendency to develop spider veins is largely hereditary, and there is not much you can do to prevent them. Support hose and exercise are helpful for symptoms, but the veins keep growing. Pregnancy and hormonal variations hasten their appearance. Reticular Veins Reticular veins are darker veins that form bluish networks that criss-cross over the thighs and lower legs. They are considered a cosmetic difficulty rather than a medical condition. They are larger than spider veins and "feed" spider veins. Ignoring them when treating spider veins can lead to less than optimal results. Varicose Veins Varicose Veins (often misspelled as Vericose) are permanently enlarged veins located beneath the skin. They become dilated and tortuous in response to abnormally high pressures seen in venous insufficiency. They are typically blue or purple, measure 3-8 mm in diameter, and have a twisted, ropy appearance. They affect an estimated 10% to 60% of the adult population, most of which are women. Varicose veins are caused by superficial venous insufficiency. As described above, superficial venous insufficiency is due to faulty one-way valves that do not close properly and allow blood to leak back with gravity and pool in the saphenous veins and their tributaries. This pooling leads to abnormally high venous pressures within malfunctioning veins which causes them to distend and balloon out, thus becoming varicosities. One of the biggest contributing factors in the development of varicose veins is heredity or family history. Other risk factors include prolonged standing or sitting, pregnancy, hormonal influences, and obesity. The incidence increases with age. Varicose veins are irreversibly damaged and do not assist in blood circulation (in fact they actually impair blood return to the heart). The body will not miss them when they are removed, and they are not suitable for use during heart bypass procedures.
Home \| Dr. Hayes \| Directions \| About Venous Disease \| Restless Legs Syndrome \| Links Entire Site © 2007 Vein Center of North Texas. All Rights Reserved.