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Varicose veins are by definition prominent, tortuous and elongated veins. This condition most commonly affects the legs but can also affect some other veins in the body. Varicose veins is a disease of evolution. It is a fairly common condition with up to 30% of the adult population in this country having some form of venous disease. The venous component of the circulation is dedicated to collecting the blood from the tissues and returning it to the heart. In the leg, the venous circulation is arranged into two systems; superficial and deep. Veins of these systems have valves at certain intervals. These valves are essential for maintaining a one way blood flow in the veins towards the heart. This one way flow is achieved by the combined action of intact valves and the "muscle pump". In an intact vein, a calf vein for example, contractions of the surrounding muscles will exert regular squeezing pressure on this vein most of the time. The valves inside the vein will only allow the blood to flow in the direction of the heart in response to this pressure. This is how we manage to "pump" the blood from the lowest parts of our bodies against gravity back to the heart. If the vein valves fail for any reason, the efficiency of this pump mechanism becomes reduced in proportion to the degree of valve insufficiency. As the apposing valve leaflets fail to meet, blood constantly gravitates in the wrong direction down the vein. This leads to a rise in the venous pressure with subsequent development of varicose veins. The means by which venous valve failure occurs are not fully understood. The process is most likely multifactorial involving a genetic predisposition that is triggered by environmental and occupational factors. The disease is much commoner in females with a female to male ration of 9:1. It can begin at any age and can affect one or both legs independently. Early varicose veins are usually not associated with any symptoms. Over the years, a variety of symptoms may develop ranging from leg ache and itching to skin discolouration and ulceration. However, the latter occurs in only 5% of patients. Treatment of varicose veins begins with a careful history and examination in order to establish the extent and severity of the disease. A decision is then taken as to whether the disease is best treated conservatively by "compression hosiery" or actively by surgery. |
When the leg muscles contract, the blood is squeezed to the heart. Valves open to allow for this flow.
When the leg muscles relax, the blood attempts to flow back down the leg under the effect of gravity. A normal valve would close to prevent this.
When valves become incompetent, blood manages to flow in the wrong direction (down the vein). This leads to the development of varicose veins.
Bilateral varicose veins.
Skin pigmentation and ulceration due to chronic venous insufficiency. |
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