About Venous Reflux
Normal veins allow blood to flow only one way, toward the heart and away from feet. They accomplish this, despite changes in position and activity, due to the presence of one-way valves. If these valves no longer work properly, or in medical terms, become incompetent, then blood can flow backward, pooling in the legs.
This is termed “reflux,” or venous insufficiency. It is also called Doppler Reflux or Venous Reflux.
 Venous insufficiency is a very common condition, and can be associated with occupations requiring long periods of standing or sitting. Pregnancy is also a significant risk factor, due to the expansion of blood volume in the mother. In women, progesterone increases the distensibility, or dilation, of the veins, further explaining the increased prevalence of the disease in females. Hereditary or genetic factors also appear to be significant.
Symptoms:
- Aching pain
- Itching
- Easily tired legs
- Leg heaviness
- Cramping
- Leg restlessness
- Ulcers
All of these symptoms usually worsen as the day progresses. Sufferers may feel the need to sit down and elevate their legs.
In more severe cases, venous insufficiency can lead to darkening of the skin and wounds, or ulcers, that can be very difficult to treat and bleed easily. One percent of adults over the age of 60 have chronic ulcers.
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About
Varicose Veins
 Varicose veins are those veins in the legs that have become elongated, bulging, and rope like. These are a complication of venous insufficiency, or reflux (see above). In the setting of reflux, the veins in the legs can become enlarged and elongated as a result of the chronic increased venous pressures, particularly when standing. In addition, there is an increase in blood volume due to blood pooling, resulting from the lack of adequate flow toward the heart. Patients may have swelling, chronic aching pain when standing for a long time, leg fatigue, cramping, and even tingling and/or numbness. Eventually, discoloration of the skin can develop. A more severe complication is a venous stasis ulcer, which can be very slow to heal due to the poor circulation.
The incidence of varicose veins increases with age, affecting roughly one half of all people 50 or older.
People with venous insufficiency may also have symptoms without having visible varicose veins. Their symptoms can be caused by pressure on nerves by the dilated veins.
There is tremendous variability in the pattern of varicose veins that any given patient may manifest, but in general there are several dominant patterns. By far the most common is reflux in the greater saphenous vein (or GSV) from the level of the groin, this being the primary venous drainage for the superficial (or skin) veins. The GSV does not usually lie on the surface of the leg, but rather is deep to the subcutaneous fatty layer. For this reason, reflux in the GSV is invisible without the use of ultrasound.
The GSV will reflux, or flow backward, down the leg until a competent valve is encountered. This valve may eventually become damaged by the increased pressures, or the vessel may dilate, so that the valve no longer works properly and the backward flow propagates further down the affected leg. The abnormal pressures may also find their way into the feeding veins from the skin by the same mechanism, i.e. damaging the valves, bleeding off the elevated pressures, and development of backward flow (reflux) into veins just under the skin. These veins become dilated and elongated, resulting in tortuous veins just under the skin that can be quite apparent to casual inspection. These are varicose veins.
It is important to understand that in the majority of cases the varicose veins that are so obvious, painful, and disfiguring are not necessary the primary problem, but rather the result of venous reflux in vessels not on the surface. It is therefore important to treat the underlying problem, such as the reflux in the greater saphenous vein described in the example above.
Treatment of Varicose Veins
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About
Spider Veins
 Spider Veins are those thin networks of vessels that appear on the skin of the lower extremities. These are abnormally dilated segments of the normal network of small veins in the skin. There is a significant genetic or hereditary predisposition to developing these abnormal vessels. In addition, progesterone stimulates the development of these abnormal veins. As a result these are more commonly seen in women, and may develop in association with pregnancy.
Although not usually symptomatic, occasionally they can be painful. They can also be unattractive and quite extensive.
The good news is that spider veins can be easily treated in many cases by local injection of a small volume of a medication, a sclerosing solution, into the veins themselves.
Unfortunately, most insurance carriers will not pay for treatment of spider veins, as they do not regard it as a medical necessity, but rather as a cosmetic problem.
Treatment of Spider Veins
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