What is Vein Disease?
Venous Disease describes the abnormality found in the Venous System, which usually results in enlarged or swollen veins that serve no useful function.
Vein Disease of the Venous System, also referred to as Venous Disease may develop in any of the three vein compartments - the Surface, Truncal or Deep Veins.
There are many different forms and grades of Venous Disease. For this reason, it may present in a wide variety of ways. Symptoms produced may vary dramatically but are often dependent on the site and severity of the Venous Disease.
Causes of Vein Disease
Vein enlargement and malfunction of the veins is caused by excessive pressure exerted by blood flow on the thin walls of veins.
Valve Malfunction is most often caused by the stretch and sag of the valve ring wall. This diagram demonstrates the difference between a normal and abnormal valve.
Vein Valve Malfunction can cause the blood to move back or pool (Reflux).
The most common presentation of Vein Disease is via the Surface Veins followed by Truncal Disease and then rarely, Deep Venous Disease.
Contributing Factors for Vein Disease
Factors that are known to contribute the sagging of valvular rings and thus valve malfunction include:
- Varicose Veins (this is the most important treatable cause for abnormal veins),
- Increasing age,
- Hormones – especially Oestrogen (female hormone),
- Occupations which involve prolonged standing or sitting,
- Strong family history,
- Pregnancy, and
- Other factors
Surface Vein Disease of the Leg
While Surface Vein disease is mainly cosmetic, patients with extensive disease often describe a burning sensation or excessive heat over the affected regions.
Abnormal veins usually develop over the upper side of the thighs and behind the knees. Later, abnormal vessels may spread to the inner thigh and lower leg.
Approximately 15 to 25% of patients who present with a sole complaint of a ‘surface vein’ problem, actually have more serious Truncal Vein Disease when examined with Duplex Ultrasound or Vascular Doppler.
Surface Vein Disease Treatment
Treatment options are almost exclusively limited to Micro-Sclerotherapy (MSC).
Truncal Leg Vein Disease
Truncal Venous Disease can present as leg ache, leg heaviness, leg pain, burning sensation, tingling and diffuse dull throbbing pain. With more severe Truncal Disease, patients may also develop; leg swelling, skin pigmentation, skin scarring and in rare occasions, skin ulceration.
Exercise rarely improves the pain and may actually worsen symptoms. This may be attributed to the fact that exercise causes an increase in leg blood flow and if the venous return is malfunctioning, then this increased load will put greater strain on the venous system, hence symptoms will become more pronounced.
Visualising Truncal and Deep Vein Disease
This Venous System at the Truncal and Deep Vein levels can not be visualised without the aid of Vascular Doppler and or Duplex Ultrasound. It is most important that a patient understands the results of a venous leg scan.
What are the Names of Vein Diseases?
Unsightly leg veins, Varicose Veins, Spider Veins, Telangiectasia, Venule Ectasia, Varicocele, Varices, Matting, Corona Phlebectasia and many more. They differ in shape, size, colour and location.
Are All Unsightly Leg Veins Abnormal?
Yes. Any vein which does not assist with the return of blood to the heart is most likely abnormal and should be treated early.
What causes Vein Disease?
Many factors contribute to the development of abnormal leg veins. The most-likely factors include; age, standing occupations, pregnancy, female hormones, obesity, strong family history and varicose veins. Varicose veins themselves, cause more veins to become abnormal.
Can Vein Disease Be Prevented?
Specialised venous support stockings may help prevent the development of abnormal leg veins in certain circumstances. Shoes with high heels restrict normal ankle movement whilst walking and should be substituted with flat-soled shoes where possible.
What problems can Vein Disease Cause?
Cosmetic disfigurement, skin damage, skin scarring, skin rashes, blue lines and discolouration, leg aches, pains, leg heaviness, leg tiredness, more Varicose Veins, an increased risk of Deep Vein Thrombosis, increased risk of Thrombophlebitis and fainting episodes.
How can leg veins be assessed?
An experienced Phlebologist may use a small hand-held Doppler unit to screen for leg vein abnormality. In addition, an Ultrasound examination will comprehensively identify the type and extent of leg vein abnormality.
How can a deep-vein problem be identified?
Deep Vein problems are usually associated with severe Varicose Veins and significant leg pain but fortunately are far less common than superficial vein problems. A specialised Ultrasound Scan is required to thoroughly assess the health of deep veins.
Will abnormal leg veins progressively worsen?
Veins are unable to repair themselves and if left untreated will worsen over time.
Does exercise help improve leg vein problems?
Exercise places a greater demand on leg veins and will not improve abnormal leg veins. Unfortunately, exercise may cause more abnormal leg veins to develop.
What effect does pregnancy have on leg veins?
Pregnancy is associated with increased blood volume, increased soft tissue relaxant hormones and increased abdominal pressure. These factors alone, may cause leg veins to become abnormal and will certainly worsen existing abnormal leg veins.
Can vein problems be inherited?
Generally speaking, patients who have family members affected by Varicose Veins are more likely to develop the condition; however there is no scientific evidence to prove or disprove this fact.
Truncal Vein Disease Treatments
Identification of disease grade is of utmost importance when planning treatment. Treatment options for vein diseases that are not superficial can include;
- Ultrasound Guided Sclerotherapy (UGS),
- Surgical Stripping
- Surgical Phlebectomy
- Ambulatory Phlebectomy (APh)
- Ambulatory Ligation (LIG)
- Endovascular Laser Ablation (EVA)
- Radiofrequency Ablation
- Vein Glue
Combination Vein Treatments
Usually a combination of treatments is employed due to the existence of multi-system disease and offers the best overall results.
Ultrasound Guided Sclerotherapy offers an alternative to repeat surgery in patients who have already had one or more surgical procedures in the past.