Signs and Symptoms of Venous Disease
Veins in the arms and legs function as the conduit that allow blood to return to the heart after carrying oxygen and nutrition to the organs, muscles, and tissues of the body. In the legs there are two major sets of veins that carry blood back to the heart, the superficial and deep venous systems. Superficial veins lie just below the surface of the skin, while the deep veins typically lie below the muscles of the leg and are typically associated with an adjacent artery that carries blood into the legs. Deep veins typically carry about 90% of normal venous return.
By the time blood reaches the furthest portion of the legs, there is little pressure left from the heart-pumping mechanism to get blood back up the legs, and so the veins rely greatly on contraction and pressure from the adjacent muscles to squeeze the veins and force blood upward and back to the heart. The blood in the leg veins also needs to move against gravity. The normal veins also have special valves which help with this process and allow blood to pass upward, then quickly close to prevent backward flow of blood back down the leg.
Varicose veins are enlarged and bulging veins that typically lie just below the surface of the skin. Problems occur when the special venous valves no longer function normally or close properly and blood is allowed to leak backward (valvular insufficiency and reflux), resulting in blood pooling and the associated increased pressure allowing the veins to dilate and bulge.
Varicose veins affect approximately 80 million Americans, including 25% of all women and 15% of all men, with up to a third of all those affected showing clinical symptoms of insufficiency.
There are many risk factors for venous insufficiency and associated varicose veins, but the most common is family history and genetics. Additional risk factors include pregnancy, female gender, obesity, sedentary lifestyle, and history of injury to the leg.
Signs and symptoms of venous insufficiency can include:
- Spider veins
- Bulging and lumpy varicose veins
- Itching
- Leg fatigue and heaviness
- Muscle pain often in the calf region
- Changes in skin coloration or thickening
- Skin breakdown or ulceration
The dilated varicose veins may even become clotted (thrombosed), resulting in a superficial thrombophlebitis with tender and painful varicose veins.
Not all patients with venous insufficiency will demonstrates large varicose veins, and these patients may develop pain or ulceration as the first signs of their venous disease.
Spider Veins: Spider veins, referred to as such because of the similarity they often bear to a spider or a spider’s web, are a mild variant of varicose veins. These are very small or tiny blood vessels that lie close to the skin. The walls of these very small veins become weak related to a variety of factors and begin to bulge at or through the skin’s surface. Spider veins can be red, blue, or purple in color. Spider veins are more common in women, but do occur in men, and are associated with a family history of varicose veins, hormonal changes, and aging.
Discomfort that is associated with spider veins is usually less severe than with larger, bulging varicose veins, but associated itching can be very annoying. Rarely, slightly larger spider veins, called reticular or telangiectatic veins, may spontaneously bleed.
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
The deep veins are those that lie deeper below the skin and muscles of the leg and tend to carry a greater amount of blood than the superficial veins. While deep veins can develop valvular problems and insufficiency, a more common problem occurs when blood clots form in the deep veins, resulting in a deep vein thrombosis that can affect a single, small vein or span the entire length of the leg.
If the clot should break loose, it can potentially travel back to the heart and lodge in the blood vessels that travel to the lungs, blocking some portion of blood flow, and resulting in a PE that can be life-threatening or result in chronic injury to the lung blood vessels (pulmonary hypertension). Pulmonary embolism occurs in about 600,000 new patients each year with about 1/3 of cases resulting in fatality. Prompt treatment may result in greatly improved survival. Risk factors for deep vein thrombosis and pulmonary embolism include immobilization or limited movement that allows blood to pool within a vein (bedrest after surgery, long car or plane ride), sedentary lifestyle, injury that limits ability to walk normally, dehydration, infection, cancer, and family history of blood clots.
Signs and symptoms of deep vein thrombosis include:
- Leg swelling
- Tenderness and/or pain in the thigh or calf
- Varicose veins that develop quickly over a few days
- Up to 50% of cases of DVT may have minimal to no symptoms whatsoever prior to travel of clot to the lungs
Signs and symptoms of pulmonary embolism may include:
- Chest pain
- Shortness of breath
- Rapid heart rate
- Cough with frothy or bloody mucous
PE is a national health problem that may result in death of up to 200,000 individuals per year.
Post-thrombotic syndrome (PTS) is a common and previously underappreciated consequence of DVT that can occur in nearly 50% of patients who develop deep vein thrombosis. The clot may cause damage and destruction of the valves of the deep veins and allow backward flow of blood in the deep veins. This may ultimately result in chronic leg swelling and pain, skin discoloration, and skin breakdown and ulceration.