What is Varicose Veins

WHAT IS VARICOSITY?

By definition, varicose veins are the enlargement, elongation, and (tortuous or twisted) deformity of the veins. Its incidence increases with age, so much so that after the age of 60, it becomes visible in various forms and in severity in the majority of the society. Although varicose veins are seen with equal frequency in men and women, it was determined that the tendency to treatment is five times higher in women.

There are two carrier vein systems in the leg, one being deep and the other being superficial. The superficial system is divided into large (vena saphenous magna-VSM) and small (vena saphenous parva, VSP) saphenous veins. Both start from the ankle; the short one is behind the knee, the longer one is poured into the deep vein in the groin area; their diameter is less than 4 mm on average.

The main vein system in the legs is the deep veins. Therefore, when the superficial veins lose their function and become varicose, they can be easily intervened. In the deep and superficial veins of the legs, there are valves that allow blood to flow towards the heart and prevent backflow. These valves have great importance in leg circulation. The valves in the superficial veins close within 0.5 seconds when we stand up or strain.

There is superficial venous insufficiency in closure weakness that exceeds this period. The volume load that occurs in the delays in closing or inability to close these valves has a physical effect that forces the vein to expand towards the ankle with the effect of gravity. In this way, with the increasing pressure in the vein, the vein and its branches begin to expand and the diseased vascular structures begin to appear on the skin. Varicose veins with diameters over 5 mm are mentioned in superficial veins. The valves in the deep veins close within 1.5 seconds in the inguinal region, in case of longer closing times, deep vein failure is mentioned.

Capillary Telangiectasias (Capillary Varicose)

Also called “spider veins,” these are located on the surface of the skin and are less than 1 mm in diameter. They are more common in women due to the effect of estrogen hormone. They are usually red in color and they cannot be palpated. However, they do not cause serious health problems.

Reticular Varicose Veins (Network-like Varices)

They are located deep in the skin and are between 1-4 mm in diameter, usually blue-purple in color and slightly raised from the skin. It is seen in approximately 80% of the adult population, and the incidence is higher in women.

Large Varicose Veins

It includes superficial main system varices. It is located subcutaneously. 80% originates from the large (VSM) superficial vein system, and 20% from the small (VSP) superficial vein system. Diameters are greater than 4 mm, and when it exceeds 5 mm, it may require medical intervention. It is seen in at least 30% of the adult population. Genetic predisposition has a role in the formation of the disease.

Internal Varicose Veins (Deep Vein Varices)

These varicose veins are not visible from the outside. They can be detected by ultrasound evaluation. It is mentioned when there is a leak in the valves of the deep vein system for more than 1.5 seconds. It is a disease that is more difficult to treat and will bring serious lifelong difficulties for patients. Sometimes it requires changes in lifestyle and habits. There are muscles around the deep veins. As the muscles contract and relax, the blood in the vein is pumped towards the heart, so a sedentary life facilitates the formation of such varicose veins.

Perforating (Deep and Superficial Connection) Varices

These varicose veins cannot be seen from the outside. They are detected by ultrasound evaluation. There are interconnecting veins called perforating veins between the deep and superficial systems. Among these, there are caps that allow blood to flow from the surface to the deep and allow one-way passage. Pressure is higher in the deep vein system, so these valves prevent the superficial system from being exposed to the high pressure of the deep system. However, when these perforating vein valves lose their function, the high pressure of the deep system begins to be transmitted to the superficial system. These reverse current forces the superficial veins to expand over time, triggering the formation of varicose veins. For this reason, perforating veins and valve functions should definitely be evaluated in ultrasonic imaging.

What are the Symptoms of Varicose Veins?

The main symptoms are:

Obtuse, progressively worsening pain in the knees, especially when standing, that ceases or subsides by extending the leg

Feeling of heaviness and fatigue in the legs (again, increasing with standing, especially towards the evening)

Tenderness on the soles of the feet (especially on the first steps in the morning)

Tingling, stinging, burning sensation in the legs

Bleeding under the skin (due to increased venous pressure, which may occur for no reason or even in the smallest bumps)

Itching

Leg cramps at nights

Restless Legs Syndrome (Especially in the evening or after lying down, the leg is not comfortable in any position)

Edema and swelling in the legs and feet (As the vein expands, its wall becomes thinner, its reticulated structure deteriorates and it starts to sweat outward due to the increased pressure inside, as a result, fluid accumulation occurs outside the vein, and this continues increasingly under the knee, especially at the ankle level, as long as you stand.When the leg is extended, the intravascular pressure drops with the effect of gravity, which disappears, and the fluids return to the vein.)

Brown discoloration of the skin and above them,watery wounds that do not heal (In advanced varicose veins, the permeability of the vein wall increases, and not only water but also red blood cells come out. Here, the bursting red blood cells leave the iron in them to the tissue, as a result, the iron causes a brown discoloration.This symptom is a sign of Chronic Venous Insufficiency.)

Varicose Complications

Untreated varicose veins never heal on their own after they form. Over time, the disease progresses and complications begin to appear, and when standing continues for a long time, serious decreases occur in quality of life and work performance.

Chronic Leg Pains

Permanent color and skin change on the leg (B) (brown color changes on the skin, thickening of the skin)

Permanent and persistent leg edema-swelling (B) (Over time, blood proteins start to come out of the vein. These proteins start to retain water in the tissue, edema becomes permanent)

Leg Wounds and Skin Ulcers

Permanent edemas cause gangrene on the skin by disrupting the circulation of the skin, and then open ulcerated wounds, these wounds are very resistant to self-closing, they constitute a very rich medium for infections, and they definitely require a long and arduous treatment process. In addition, due to increased venous pressure, there may be spontaneous or post-traumatic bleeding that is difficult to stop in the leg. The blood flow slows down in the varicose and enlarged veins with vein occlusions (thrombophlebitis). In cases where the integrity of the skin is impaired, such as foot or nail fungus, shoe hits or ingrown nails, the microbes entering from these areas find it easy to create infection by clinging to the vein wall, whose structure is also impaired.

The infection-inflammatory reaction in the vessel wall triggers coagulation. As a result, it causes coagulation and obstruction in the deep or superficial vein system, and when the blood coming from the arteries has difficulty returning, it causes severe painful swelling and limitation of movement in the leg. The resulting clots and infection are met with an inflammatory reaction by the body, and this reaction has devastating effects on the vessel wall and its valves. The secretions released by the defense cells to dissolve the clots or to kill the pathogens indiscriminately cause damage to the tissue. Once the vascular structure and valve are damaged, infection and coagulation begin to occur more easily, and over time, the process enters a vicious circle, making medical interventions to break the chain difficult.

Pulmonary Clot (in deep vein coagulation-occlusion)

Valve failure and slowing blood flow after enlargement in the deep vein can lead to many serious consequences by causing coagulation, as described above in the mechanism of thrombophlebitis development, that may even result in death. In the presence of a genetic predisposition to clotting, pooling of blood (stasis) in the deep vein can lead to sudden and fatal pulmonary clotting at any time in life.