Arteries carry blood AWAY from the heart to the rest of the body. Veins carry blood TOWARD the heart, and one-way valves in the veins stop the blood from flowing backward. When veins have trouble sending blood from the limbs back to the heart, it is called venous insufficiency. Blood will pool in the veins in the legs when blood doesn’t flow back properly to the heart.

Healthy veins provide a continuous flow of blood from the limbs back toward the heart. Improper functioning of the vein valves in the leg will cause swelling and skin changes.

Venous insufficiency is most commonly caused by blood clots (deep vein thrombosis) and varicose veins. Symptoms of venous insufficiency include varicose veins, swelling, or skin color changes on the affected leg. If the condition progresses, leg ulcers can form.

Treatment includes compression stockings, elevating the legs, and moisturizing the skin. In severe cases, surgery may be needed to improve blood flow.

What causes vein problems?

Valves within the veins of the legs help prevent the backflow of blood. The most common causes of venous insufficiency are either blood clots or varicose veins. When blood flow through the veins becomes obstructed, such as a blood clot, blood builds up below the clot, which leads to venous insufficiency.

In varicose veins, the valves are often missing or impaired which allows blood to leak back through the damaged valves. Venous insufficiency is more likely to occur in adults over the age of 50, and is more common in women than in men. Another cause of venous insufficiency includes weakness in the leg muscles that should be squeezing venous blood toward the heart.

What increases the risk for venous insufficiency?

• blood clots
• varicose veins
• obesity
• smoking
• leg injury
• swelling

What are symptoms of venous insufficiency?

• swelling of the legs or ankles (edema)
• leg cramps
• aching or throbbing pain in the legs
• weak legs
• skin that changes color around the ankles
• leg ulcers

How to treat venous insufficiency?

The most common treatment for venous insufficiency is compression stockings. These special elastic sleeves apply pressure at the ankle and lower leg. They help improve blood flow and can reduce leg swelling. Compression stockings come in a range of compression strengths and different lengths. Your doctor will help you decide what the best type of compression stocking is for your treatment.

Helpful tips to improve blood flow include:

• Keep legs elevated
• Wear compression stockings
• Regular exercise

Medications can include:

• Diuretics (helps pull extra fluid from your body that is then excreted)
• Anticoagulants (blood thinners)
• Trental (helps improve blood flow)

Does venous insufficiency require surgery?

More serious cases of venous insufficiency may require surgery.

Surgical repairs can include:

• Repair veins or valves
• Removing damaged veins
• Minimally invasive endoscopic surgery (thin tube with a camera to tie off varicose veins)
• Vein bypass (a healthy vein is transplanted from somewhere else in the body)
• Laser surgery (lasers close the damaged vein with strong surges of light in a specific place)

Varicose veins

Varicose veins are enlarged, swollen, and twisted veins that appear blue or dark purple most commonly in the legs and feet. Varicose veins form when faulty valves in the veins allow blood to flow in the wrong direction or to pool. Varicose veins can cause discomfort with aching pain.

Arteries carry blood away from the heart to the rest of the tissues, and veins return blood from the rest of the body to the heart. Veins in the legs must work against gravity to return blood to the heart. Weak or damaged valves can lead to varicose veins. Varicose veins that develop during pregnancy generally improve without medical treatment within three to 12 months after delivery.

What are symptoms of varicose veins?

For many people, varicose veins are simply a cosmetic concern. Symptoms of varicose veins can include veins that appear dark purple or blue and appear bulging. Skin discoloration around a varicose vein may occur and pain can worsen after sitting or standing for a long time. In other cases, they can cause aching pain and discomfort signaling an underlying circulatory problem. Any superficial vein may become varicosed, but the veins most commonly affected are those in your legs because standing and walking increases the pressure in the veins of the lower body.

Common varicose vein treatment

Treatment usually involves compression stockings, exercise, or procedures to close or remove the veins. Compression stockings steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand. Varicose veins are usually treated on an outpatient basis.

Improving your circulation and muscle tone may reduce your risk of developing varicose veins or getting additional ones. Some tips to prevent varicose veins may include exercising, a low-salt diet, changing your sitting or standing position regularly, and elevating your legs. The same measures you can take to treat the discomfort from varicose veins at home can help prevent varicose veins.

Sclerotherapy for varicose veins?

Sclerotherapy procedure injects small and medium-sized varicose veins with a solution that scars and closes those veins. In a few weeks, the treated varicose veins should fade. The same vein may need to be injected more than once, but the therapy is usually effective. Sclerotherapy does not require anesthesia and can be done in the office.

Laser technology treatments close off smaller varicose veins and spider veins by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used.

What is vein surgery?

Catheter-assisted procedures using radiofrequency or laser energy is the preferred treatment for larger varicose veins. The physician inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter using either radiofrequency or laser energy. When the catheter is slowly pulled out, the heat destroys the vein by causing it to collapse and seal shut.

High ligation or vein stripping procedures involves tying off a vein before it joins a deep vein and removing the vein through small incisions. Removing the vein should not affect circulation because veins deeper in the legs take care of the larger volumes of blood.

Endoscopic vein surgery is reserved for only advanced cases involving leg ulcers when other treatment techniques fail. The physician uses a thin video camera inserted into the leg to visualize and close varicose veins and then removes the veins through small incisions.

Spider veins

Spider veins (also called telangiectasias) are clusters of tiny red, blue, or purple blood vessels commonly found on the face and legs and have the appearance of a spiderweb. Spider veins are similar to varicose veins, but they’re smaller. Spider veins are small, dilated blood vessels that can occur near the surface of the skin or mucous membranes. It is now understood that venous reflux disease is usually the cause of these problems.

What are spider veins?

Spider veins in the legs can be associated with venous reflux from underlying varicose veins. Spider veins can be caused by flow abnormalities within veins of the leg (reticular veins).

Venous hypertension can cause spider veins. Some spider veins may be composed of abnormal aggregations of arterioles, capillaries or venules. Because telangiectasias are vascular lesions, they blanch when tested with diascopy.

Who treats spider veins?

Vascular surgeons or phlebologists specialize in vein care or peripheral vascular disease. Interventional radiologists have started treating venous problems.

Factors that predispose to the development of varicose and telangiectatic leg veins include age, gender, pregnancy, tobacco smoking and lifestyle. In men, they are related to high estrogen levels secondary to liver disease.

Where to get treatment for spider veins?

Before any treatment of leg telangectasia (spider veins) is considered, it is essential to have duplex ultrasonography because there is a clear association between leg telangectasia (spider veins) and underlying venous reflux. It is essential to find and treat underlying venous reflux before considering any treatment at all.