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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.