What is chronic venous disease?
Key terms: chronic venous disease, varicose veins, spider veins, reflux, increased pressure, inflammation
Chronic venous disease occurs when the veins in the body become incapable of efficient return of the blood to the heart. This happens most commonly in the lower extremities, or legs, of adults. It is estimated that 20% of the adult population has some form of this problem. As the disease progresses there are a range of signs and symptoms depending on the severity of the problem. The visible signs range from tiny clusters of superficial veins in the skin (commonly referred to as spider veins) to the larger visible varicose veins. In more severe cases edema (swelling), redness, brown skin discoloration, and skin breakdown occurs. Common symptoms include heaviness, aching, restlessness, and itching.
The mechanism or pathology of chronic vein disease most often centers around a condition called reflux. Reflux is backward flow, usually occurring in the major superficial veins of the legs. In the normal state of health, the veins serve as the conduit to carry blood back to the heart once it has provided oxygen and nutrition to the tissues in the legs. A key element in the ability of the blood to move toward the heart is a system of one-way valves that allow the blood to flow out of the legs and toward the heart, but not in the reverse direction. For a number of reasons these one-way valves in the leg may fail, allowing backward flow of blood in the veins toward the feet. The consequence of this backward flow is increased pressure in the veins. The pressure is highest in the veins when we are standing or sitting for prolonged periods. Increased pressure can lead to leakage of fluid from the bloodstream into the tissue, producing swelling or edema. Increased venous pressure also causes the spillage of proteins and red blood cells into the tissue resulting in inflammation, scarring, and interference with the delivery of oxygen and nutrients to the tissue. Often, the visible signs of this problem are apparent in the lower legs and skin just above the ankles as edema, redness, and tan or brown skin staining. This is not just a cosmetic problem. Even patients with relatively early chronic vein disease have impaired circulation and chronic inflammation in the soft tissue that gradually worsens over time.
The good news is chronic venous disease is very treatable, most often with in-office procedures under a local anesthetic (numbing the areas treated similar to what is done by your dentist). These minimally invasive treatments allow patients to have corrective procedures, drive themselves home the same day, and return to work the next day with minimal discomfort and downtime. In addition, treatment of significant reflux often eliminates symptoms completely and prevents worsening of this condition, and the progression to more complex problems in the future.