Op. Dr. Orhan Coşkun
Varicose veins are a condition affecting the veins, specifically the veins known as ‘veins’ in medical terminology. Veins are vessels that return deoxygenated (impure) blood, used by tissues anywhere in our body, back to the heart. When these veins are unable to perform their usual functions and encounter issues with blood circulation, they can expand, become twisted, and visible. Over time, this condition may become chronic and progress. In such cases, we refer to this condition as varicose vein disease.
The structure of the veins that form varicose veins in the leg:
Understanding the structure of the veins in the leg helps us better comprehend varicose veins. If we liken arteries to the clean water supply network of a city, veins are like channels that transport wastewater back to the central system for purification. In the leg, there are 1- deep veins accompanying arteries (known as femoral and popliteal veins), 2- superficial veins (small and great saphenous veins), and 3- perforating veins connecting deep and superficial veins.
Is varicose veins only seen in the legs?
Since these veins are present throughout our body, varicosities can occur anywhere. For example, around the esophagus, in the anal region (hemorrhoids), in the testicles in men (varicocele), on the feet and calves, around the female reproductive organs, in the abdomen, and in the arm regions.
However, the most common form we encounter is in the lower part of our body; the feet, legs, and calf regions. Since veins in these areas transport blood towards the heart against the force of gravity, the likelihood of varicose veins is higher.
Is venous insufficiency different from varicose veins?
In the veins of the lower part of our body, there are valves that prevent the backflow of deoxygenated blood to the heart. These valves operate with a system called ‘Check-valve,’ meaning they open in the direction of blood flow, allowing passage, and close in the opposite direction, preventing backflow. When there is a dysfunction in these valves, the blood flow upward reverses, leading to a backflow towards the leg.
This backward flow is referred to as reflux, and the condition that arises from it is called venous insufficiency. The term reflux is a general expression used in medicine, indicating a backward escape. Venous insufficiency is classified into four degrees based on the duration of this backward flow. This condition is diagnosed using Doppler ultrasound, and it is crucial in determining treatment options.
The chronicization of reflux can lead to the formation of varicose veins and may contribute to the development of many other ailments. The cause of varicose veins commonly found in the legs and feet is often the malfunction of these valves and reflux. In other words, varicose veins in the leg region may often conceal a larger underlying issue, like an iceberg. Sometimes, venous insufficiency can exist without visible varicose veins in the patient.
Do types of varicose veins exist?
When we talk about varicose veins, it seems that there are two fundamental situations:
1- Varicose veins accompanied by venous insufficiency
We can categorize this into deep insufficiency (in femoral and popliteal veins), superficial insufficiency (in the saphenous vein), and perforator insufficiency (connecting veins between deep and superficial veins). Each of these can occur individually or coexist. All these insufficiency conditions can contribute to the formation and rapid progression of varicose veins.
2- Visible varicose veins without advanced venous insufficiency
Varicose veins are also classified based on their size and extent. This includes telangiectasia or spider veins, which are as fine as a hair, to varicose veins that extend to the width of a finger and appear like clusters. Varicose veins can have a broad profile, ranging from thin spider veins to larger varicose clusters.
In advanced stages, thickening of the skin, eczema, changes in color, and varicose ulcers may also occur.
What are internal and external varicose veins?
These terms are coined to provide information to patients about the prevalence and causes of the disease. Internal varicose veins are primarily used to better express the malfunction and insufficiency of the unseen venous valves beneath the surface of the skin. When these issues become visible on the skin’s surface, they are referred to as external varicose veins.
What is venous hypertension?
Due to the backward flow of blood in the leg veins caused by venous insufficiency, there is an increased accumulation of blood within these veins, leading to a gradual increase in internal pressure. This is one of the consequences of venous insufficiency disease, and the increase in intravascular pressure can result in some pathological effects, causing symptoms such as changes in the skin, edema, pain, burning, and cramps.
Is vein obstruction the same as varicose veins?
Obstructions formed by the accumulation of clots in deep or occasionally superficial veins are not considered varicose vein disease. This condition may, over time, create a groundwork for the development of varicose veins, or venous insufficiency and varicose veins may have contributed to this condition. The treatment approaches also differ in these cases.
