Venous Insufficiency, Varicose Veins
Venous leakage or “insufficiency” occurs when the specialized valves in the vein and the wall of the vein adjacent to the valve begin to weaken and blood is allowed to leak back down the vein after the blood is pumped upward. This leakage may be caused by a variety of factors although heredity plays a large role, as many patients have a strong family history of venous insufficiency and varicose veins. Hormonal changes, such as those that occur during pregnancy or hormone replacement therapy also weaken the veins and their valves and initiate venous leakage. Other factors such as trauma or previous blood clots in the veins of the legs (venous thrombosis) may damage or destroy valves in the veins and also cause venous leakage. Prolonged standing, as often encountered in the workplace, can definitely exacerbate and worsen venous leakage, but it is not typically the initial cause of the venous leakage.
With time, venous leakage will cause progressive bulging and dilatation of the vein.
Initially, when venous leakage occurs, the leakage is often only minimal and an individual may notice no discomfort or outward sign of the problem. Venous leakage that occurs after pregnancy may resolve in the six months or so after delivery. However, in many cases, when leakage occurs it will cause the vein below the leaky valve to bulge and balloon out, further widening and weakening the already leaky valve, worsening the problem. At this point, a progressively worsening cycle is initiated and venous leakage and varicose veins will only continue to progress.
The majority (greater than 90%) of venous leakage occurs in either of the two main saphenous veins, the greater saphenous the or short saphenous. While venous leakage, when it occurs, is usually most severe in these veins, the saphenous veins do not usually bulge through the skin as other veins do because these two main veins usually have a tough fibrous covering (fascia) that only allows mild bulging that is not visible to the eye. The branches of the vein, however, have no fibrous fascial covering and when the leaking blood rushes back into these veins they will begin to balloon and become the typical unsightly varicose veins with which everyone is familiar.
While not typical, venous leakage can occur in the deep veins of the leg. It is fortunate that this pattern of venous leakage is not as common as leakage in the superficial veins, as it can be extremely difficult to treat and result in serious swelling, pain and very progressive skin changes. Definitive treatment options may not be available and only conservative treatment options may be possible.
