Information on venous insufficiency
Chronic venous insufficiency is a chronic and progressive disease in which the venous system cannot perform its function properly. In other words, it is difficult for the blood to return effectively from the feet to the heart. It mainly affects the superficial venous system (very rarely the deep venous system, which is more serious).
It is a very common disease. It is estimated that 20-301PT3T of the adult population suffers from some degree of chronic venous insufficiency (sustained and aggravated over time) and it is more prevalent in women than in men. Although men tend to consult later and in more advanced stages of the disease.
The most common symptoms caused by this disease are muscle fatigue and pain in the calf when standing for long periods, restless legs, night cramps or oedema (swelling) at the ankle. These symptoms are worse in the warmer months.
The most visible signs of this disease are varicose veins.
From the mildest (and most frequent) to the most severe (less frequent) forms.
This includes telangiectatic veins (spider veins) and reticular veins. Spider veins are the smallest of all, ranging in size from 0.1 mm / 1-2 mm. They are transparent on the skin and are located in the dermis. They can be red or purplish-blue with a greenish tinge when they have a thicker vein underneath (nutrient vein). The smaller ones do not bulge although they may form clusters and bulge into the skin.
Sometimes, they are part of other more serious diseases: collagen diseases, skin diseases, ...
Dilated reticular veins are 3-4 mm in size. They have a subdermal location and often pressurise a group of spider veins.
The most widely recommended treatment for these two types of varicose veins is sclerotherapy. This consists of introducing a substance inside the vein to cause irritation, hardening and its disappearance over time. Prior to treatment, in the first consultation, an exhaustive study of each case is carried out, including an ultrasound examination. Although it is not common, there may be a truncal insufficiency underneath spider veins.
This stage includes the typical thick varicose veins seen in the legs. It is a dilatation of the tertiary network or tributary veins connected to the saphenous veins. It is very important to determine where the leakage point that causes these varicose veins is located. To do this, it is essential to carry out a Doppler ultrasound scan. The ideal treatment involves eliminating the leakage point (great or lesser saphenous arch, insufficient perforator, pelvic leakage, etc.). Catheter techniques (especially laser and radiofrequency) have been displacing conventional surgery due to their high effectiveness, few complications and comfort in the postoperative period (generally no need for sick leave).
Formed by patients whose main symptom is swelling of the legs (oedema), with or without varicose veins. This swelling improves when the legs are raised.
It is important to rule out that the oedema is due to venous insufficiency and not to multiple other causes (kidney disease, heart disease, lymphoedema, etc.).
It is marked by skin changes: more pigmented skin on the legs, itching, flaking, hardened skin, ... often accompanied by visible varicose veins. Treatment of varicose veins and venous insufficiency reflux often improves skin symptoms.
Sometimes, they are part of other more serious diseases: collagen diseases, skin diseases, ...
Dilated reticular veins are 3-4 mm in size. They have a subdermal location and often pressurise a group of spider veins.
The most widely recommended treatment for these two types of varicose veins is sclerotherapy. This consists of introducing a substance inside the vein to cause irritation, hardening and its disappearance over time. Prior to treatment, in the first consultation, an exhaustive study of each case is carried out, including an ultrasound examination. Although it is not common, there may be a truncal insufficiency underneath spider veins.
Ulcer that has healed.
Active ulcer, usually on the inside of the ankle. They are painless unless infected. The adjacent skin is usually indurated and pigmented and often has an insufficient vein nearby (perforating) that nourishes it. Treatment of this vein is essential for the ulcer to heal. It is sometimes difficult to locate.
Information on varicose veins
Varicose veins are abnormal dilatations of the veins (they can occur almost anywhere in the body, but we will focus on those in the lower limbs). Their course becomes twisted and tortuous and they are clearly visible as "bulges" in the legs.
They occur due to an inability of the venous wall to maintain its function (propelling blood back to the heart). The hydrostatic pressure of the blood column causes continuous and constant damage to the venous valves, which eventually damages them and triggers dilation and functional failure. It is a vicious circle which, once it occurs, can no longer be reversed. Varicose veins are the visible face of chronic venous insufficiency.
The most common location is in the lower limbs (legs and thighs) where the veins have the difficult task of pushing blood back to the heart, against the force of gravity. To do this they have:
It is important to note that 90% of the venous flow in the lower extremities runs through the deep venous system. The veins of the deep venous system are not the veins that dilate in varicose veins. These are superficial (subcutaneous) veins that dilate.
In addition to the genetic factor, which plays a very important role in the development of varicose veins, there are important risk factors, such as: prolonged standing or sitting without moving the legs (often for work-related reasons), age, obesity, hormonal fluctuations such as those that occur during pregnancy (multiple pregnancies are an important risk factor), menopause or the use of hormonal contraceptive devices.
The dilated vein itself does not "usually" hurt (although it does occasionally cause discomfort or an itchy sensation). When it really hurts, it can be a more serious problem, known as superficial thrombophlebitis. In these cases the pain comes on suddenly, is accompanied by reddening of the skin and local heat. This is a complication that sometimes occurs in large varicose veins.
The symptoms you notice are typical of chronic venous insufficiency (as mentioned above, a varicose vein is a visible sign of poor circulation in the superficial veins of the legs):
Feeling of "dull" pain or heaviness in the legs, especially when standing for long periods of time and in the first months of hot weather.
Itching around the area of the varicose veins.
Swelling of the legs and ankle area.
In advanced and more severe stages, skin changes (stasis dermatitis) may be observed, with more pigmented, scaly, itchy and hardened skin. Ultimately, they may develop into an ulcer that is difficult to treat (typically on the inside of the ankle).
All these symptoms can be alleviated with:
Compression stockings, gentle exercise (walking, water aerobics), elevating the legs, cold water baths and some drugs can improve the discomfort. Specific treatment of varicose veins is also a therapeutic gesture that usually improves all these symptoms.
As explained above, varicose veins are superficial veins that dilate. There is no increased risk of serious thrombosis (deep vein thrombosis), but localised thrombosis of the varicose vein or saphenous vein (superficial thrombophlebitis) is common and can sometimes require anticoagulant treatment for 45 days.
Varicorrhagia (bleeding from even the slightest trauma) can also occur in a very superficial varicose vein.
Chronic venous insufficiency can evolve in the stages described above, if the appropriate measures are not taken: wearing compression stockings, avoiding standing, obesity, avoiding direct heat sources, ...
A varicose vein is a vein with an irreversibly unstructured vein wall. On its own, it will not return to its healthy state.
However, it is possible to delay their degeneration and prevent them from worsening and arising further:
Wear thigh-high or knee-high compression stockings. (mild or medium compression).
Do not wear high-heeled shoes on a regular basis.
Move the calf muscles when standing or sitting for long periods of time.
Do not wear clothing that is too tight to act as a tourniquet.
Rest with legs elevated.
Baths with cold water and avoid direct sources of heat on the varicose vein.
Gentle sport (daily walking and water aerobics).
Slimming.
Sometimes drugs can help with the symptoms. However, what is most effective and makes varicose veins disappear is direct treatment: sclerosis of the veins / catheter treatment of an insufficient vein.
If the discomfort prevents you from carrying out everyday activities, it is time to consult a specialist. If you have had episodes of superficial thrombosis, bleeding, skin changes as described above or an active ulcer, it is also time to consult a specialist.
What is it?
Varicose veins inside the pelvis (lower abdomen) can cause discomfort. The most common are chronic pelvic pain (more than six months) that worsens when standing and throughout the day. Dyspareunia" (pain before, during or after sexual intercourse) and "perineal heaviness" are also common symptoms. In the presence of these symptoms, it is important to rule out gynaecological or urological causes.
Apart from the symptoms, there are signs that indicate the probable existence of pelvic varicose veins. The most frequent are atypical varicose veins, varicose veins at pelvic leakage points and genital varicose veins.
Sometimes gonadal and pelvic veins are dilated, especially in women with several children, and do not necessarily need treatment.
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