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Understanding Saphenous Veins

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima vein care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

Every week I will write a short article that I hope will help you understand the problem and the treatment of varicose and spider veins.

Last week I wrote about the valves in veins. You can think about the superficial vein system like an upside down tree. Most peoples legs have two or three trunks. The largest trunk in the so called “great saphenous vein.” It begins in the groin and goes down to the ankle on the inside of the leg. The next largest trunk is the short saphenous vein in the back of the calf. It usually begins at the knee in the back of the leg and goes down the middle of the back of the leg and then veers toward the outside of the ankle. Then, sometimes, there can be a vein in the front of the thigh called the “anterior duplicated saphenous vein” and it goes down the front of the thigh and then may go to the outside of the thigh.

The course of the great saphenous vein is quite reliable but there are interesting variations. One of the things that surprised me when I took my anatomy class in medical school is that people are as different inside as they are outside. About 8% of people have a so-called duplicated great saphenous vein in the thigh. In people who have this variation two veins run next to each other for some distance and then rejoin. It is important during ultrasound examination to recognize this variation when it occurs. Both branches of the duplicated vein may need to be treated in order to achieve a long-lasting cure of the varicose veins. This variation is even more common below the knee. There are branches of the great saphenous vein that almost always occur and others branches that are unusual. In examining individuals it is important to know about these variations.

The small saphenous vein has even more variations. Most of the time it begins in the back of the calf at the level of the knee. But it may begin above the knee, or rarely, below it. In fact, it may connect to the great saphenous vein in the middle of the thigh and not directly connect to the deep veins at all.

Knowledge of the variations is extremely important in planning therapy.

If the valves are working correctly then the vein is said to be “competent”. If the vein valves are not working correctly then the vein is said to be “incompetent”. It is incompetent valves that cause varicose veins. These valves cannot be repaired. Forty years of research have gone into finding ways to repair these valves and so far no way as been found. Veins of the superficial system of the leg are really too small and too delicate to repair.

Methods of treatment mostly consist of selectively destroying trunks and branches of the superficial vein system. I’ll write about this next week.

What Are Varicose Veins?

There are three types of blood vessels in humans. Arteries, veins and capillaries. Capillaries are microscopic and although they are all over your body, there are fortunately few problems the are associated with capillaries. Arteries are very important. They carry blood from the heart to all the organs. It is artery disease that leads to many of the worst life threatening problems. Atherosclerosis, or “hardening of the arteries, causes high blood pressure, heart attacks, stokes, sometimes kidney failure and is the most common fatal illness in the U.S. Artery disease is mostly a result of tobacco and our rich, fatty diet. Arteries are located deep inside and so most of the problems don’t become apparent until they cause severe symptoms.

Vein disease is different. There are lots more veins than arteries. They carry blood from the organs back to the heart. They do so, against the force of gravity because most of them have valves that make the blood go up and not fall back down. If the valves are working, the vein is called “competent”. If the valves are not working and blood goes backwards in the vein, the vein is called “incompetent.”

In the leg, there are two systems of veins, the deep system, which is down deep inside the leg muscles, and the superficial system, which is just under the skin.

Valve incompetence is common in the superficial system of veins in the legs. The deep system is contained by the muscles and the tough tissue called “fascia” but the superficial vein system is contained by skin,which can stretch. Anything that raises pressure in the vein system, like jobs that require standing, or pregnancy, will cause the superficial veins to stretch, and one valve can become incompetent. That puts more pressure on the next valve, and then pop, pop, pop, people get varicose veins.

You can think about the superficial vein system like an upside down tree. There are trunks, and branches and twigs. What you see and feel on the surface of the legs are the branches and twigs, but that often indicates incompetence in the trunks. Most peoples legs have two or three trunks. The most commonly affected trunk in the so called “great saphenous vein.” It begins in the groin and goes down to the ankle on the inside of the leg. So varicose veins in the middle of the thigh or the middle or front of the leg are usually due to incompetence in the valves of the greater saphenous vein. The next most commonly affected trunk is the short saphenous vein in the back of the calf. Varicose veins in the back or outside of the calf often come from this trunk. Then, sometimes, there can be a vein in the front of the thigh called the “anterior duplicated saphenous vein” and that can cause varicose vein on the front or outside of the thigh.

With duplex Doppler, that I talked about last week, we can examine your leg and find the underlying problem.

Laser Treatment for Varicose Veins

My name is Ken Seifert, M.D.  I work at Optima Vein Care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

I am a Vascular Surgeon who is certified in Vascular Surgery by the American Board of Surgery.  I have been doing surgery on arteries and veins for 35 years.  In the last 15 years there has been a transformation in the treatment of varicose veins.  This has been mostly due to the introduction of benign, minimally invasive treatments that replaced the dreaded vein stripping operation and also due to the development of ultrasound as a diagnostic tool.

Twenty years ago, if you went to a physician complaining of varicose veins, you might have been referred to a vascular surgeon like me.  I would have tried to persuade you to wear elastic support stockings because vein stripping was a painful procedure that required general anesthesia and hospitalization.  It seemed to me that unless your problem was very bad, it was better to put up with it or to wear elastic support stockings every day for the rest of your life than to go through a vein stripping.

That has all changed.  It is now routine for patients with varicose veins to see a vascular surgeon like me, get an ultrasound examination in my office, get insurance approval and have treatments in my office done under local anesthesia that will make your varicose veins stop hurting and no longer be visible.  I close the major veins with a laser, heating it and sealing it closed.  I do this under local anesthesia.

Lasers get all the glory but the real star of the story is ultrasound.  Everyone has experienced what is called “the Doppler effect”.  When a police car or fire engine passes you with its siren blowing, you hear a change in the tone of the siren.  This is the Doppler effect.  It is named after a 19th century Austrian scientist, Christian Doppler, who first described it.  Sound emitted or reflected off a moving object will be changed in frequency, or tone, by the motion and the change depends on the speed and direction of that motion.  By bouncing high frequency sound off the moving red blood cells in your arteries and veins I can tell how fast they are going and in which direction.  In the 1980s that fact was used to develop equipment, mostly at the University of Washington in Seattle, to produced images of blood vessels and displayed a color that was related to how fast and in what direction, the blood was flowing in those blood vessels.  At first the equipment was expensive, cumbersome and difficult to use, but it has now become affordable, transportable, and relatively easy to use so that every vascular surgeon can have one or two of these machines in their office and I can use it to determine which way the blood is flowing in your veins.  It is easy to do and involves no needles or pain.

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