What is Venous Insufficiency (Vein Disease)?
Veins are blood vessels that move blood to the heart. These are thin-walled structures with valves inside them, which prevent back-flow. The blood that leaves the heart is oxygen-rich and distributed throughout the body through thicker blood vessels called arteries.
Veins located near the skin surface are called “superficial veins” and those found in the muscles are called “deep veins”.
As we age, as we experience health issues or even genetic predisposal, our veins start we weaken and the valves may begin to let blood flow backward. This creates a pressure buildup within the vein, causing its walls to stretch and twist and become damaged as the blood pools. Damaged veins can lead to valve insufficiency, slower blood flow, and possible blood clots. Eventually, this will result in a range of disorders collectively known as “Vein Disease”.
Signs and Symptoms of Vein Disease
Vein disease is fairly easy to identify. It is usually characterized by blue, red, or purple swollen veins that may be twisted or elongated. Some patients report an itchy sensation around the swollen veins. Others even have bruising and discoloration. More severe cases are described with throbbing or burning feeling that is more apparent at night.
Causes of Vein Disease
Blood flows to the heart through the veins. It moves in one direction and backflow is prevented by valves. As you age, the walls of the blood vessels weaken: they gradually lose their elasticity which causes the blood to pool within an area and prevent forward flow.
The most common starting points of vein disease are the legs. It is simply because they are farthest from the heart, which means lesser pressure. Another inevitable proponent is gravity because it prevents the flood from flowing upwards.
While subject experts can’t determine the exact cause of vein disease, they listed the factors that can increase one’s chances:
Types of Vein Disease
Varicose Veins
These are swollen veins close to the skin surface, which may be twisted or elongated. Varicose veins develop when blood flows backwards due to defective or weak valves, or when blood stays within a vein for a long time.
When blood stagnates, it pushes the walls of the veins outwards. They lose elasticity each time it happens until the walls cannot go back to their original form and they become enlarged.
This is common among people who stand or sit for extended periods. Pregnancy, being overweight, and tumors can also cause varicose veins due to added weight.
More common to women than men, they are usually found in the legs because it is farther from the heart. The distance, gravity, and weight delay the flow of the blood to the upper part of the body.
Superficial Vein Thrombophlebitis
When a blood clots within a vein, the tendency is blood flow will be restricted. This increases pressure in the other veins, causing them to become inflamed. It usually occurs in the legs and is identified by a swollen, tender vein. If it is near the skin surface, it is called superficial thrombophlebitis (SVT).
Even if it is in the superficial part of the body, SVT is regarded as a benign condition because it can still trigger a number of health issues. SVT shares the same risk factors of other thrombotic conditions. Diagnosis is normally based on the symptoms. The treatment options are varied with the objective of preventing complications and relieving symptoms.
Symptoms include presence of warmth, pain, redness and swelling in the superficial vein.
Deep-vein Thrombophlebitis
This condition affects the veins that are located in the deeper part of the body. Deep-vein thrombophlebitis (DVT) is more serious and affects larger veins. Symptoms are not usually readily apparent, but this condition can put you at risk of pulmonary embolism and chronic venous insufficiency.
Pulmonary embolism is when a blood clot loosens from its original place and goes to the lungs.
Chronic venous insufficiency is diminished blood flow through the veins causing swelling, dermatitis, and increased skin pigmentation.
DVT is characterized by swelling, redness, tenderness, and pain in the distended vein, although many reported DVT cases are asymptomatic. Signs and symptoms are not considered sufficient for diagnosis, but they can help determine the risk of DVT when combined with risk factors.
Diagnosis involves assessment through clinical prediction rule, and is confirmed by ultrasound of the affected vein. The standard treatment for DVT is anti-coagulation, where the patient is prescribed with a blood-thinning medication.
Diagnosis of Vein Disease
Diagnosis starts with a physical examination that involves locating swollen veins. This is supplemented by review of your medical history.
A vein specialist will examine your legs while standing or sitting. He/she will look for enlarged veins, which may be purple or blue-ish. Sometimes the veins are also twisted. Any discoloration or swelling will be noted as well.
You will be asked if you feel any warmth, pain, tenderness, or cramping in your legs. It is also important to reveal if you have a family history of varicose veins, SVT, or DVT.
The vein specialist may also order to run an ultrasound test on the swollen areas. This is to check the condition of the valves, since vein disease is caused by defective vein valves that prevent flood from flowing forwards and causing it to pool in certain areas. Furthermore, an ultrasound is a great way to check for blood clots, which are serious side effects of vein disease.
Treatment of Vein Disease
Sclerotherapy
This treatment method is typically used for varicose veins.
In sclerotheraphy, the damaged vein is injected with a chemical that causes it become unable to carry blood. As a result, blood will go back to the heart through another vein and the damaged vein will atrophy.
Sclerotherapy is used for targeting small to medium-sized veins. The procedure takes only 10-15 minutes to perform and has minimal downtime. It is also less invasive compared to vein surgery.
The sclerosant solution also shrinks the feeder veins under the skin, preventing re-occurrence of spider veins. You may be required to wear stockings for at least two weeks after the treatment to encourage healing. For significant results, you need multiple treatments spaced by several weeks.
Superficial Vein Thrombophlebitis
SVT may lead to a serious complication called “pulmonary embolism” because a blood clot in the extremities can travel to the lungs. This happens when the blood clot migrates from superficial veins to deeper veins.
The main objective of SVT treatment is to diminish inflammation and prevent SVT from extending from its original place. Treatment may include physical activity, compression, medications, and surgery.
Compression
Different compression bandages are used to manage different cases of SVT. These include adhesive short stretch bandages, fixed compression bandages, and graduated elastic compression stockings. Compression apply pressure on the swollen site to discourage further fluid accumulation.
Physical Activity
Individuals with SVT are encouraged to become more physically active. Inactivity or sitting or standing for extended periods promotes fluid accumulation and cause the SVT to elongate, increasing risk clinical complications.
Medications
Medications prescribed for SVT patients include NSAIDs (except aspirin), anticoagulants, corticosteroids, and antibiotics.
Anticoagculants are medications that prevent blood clots. They are usually given to individuals at high risk of developing blood clots.
High risk SVT patients may be prescribed with novel oral coagulants or vitamin K antagonists for 3 months. Intermediate cases are usually treated using fondarinux, which is to be taken for 45 days at 2.5 mg daily. Low molecular weight heparin is also a standard medication for intermediate SVTs.
NSAIDs
Non-steroidal anti-inflammatory drugs, in oral or topical form, are used to relieve SVT symptoms. Randomized trials also showed that NSAIDs can help prevent extension and reoccurrence of SVT.
Surgery
Surgical interventions aims to relieve mild to complicated SVTs. It normally involves ligation or stripping of the damaged vein.
Anticoagulation Therapy and Physical Activity
DVT patients are prescribed with anticoagulants to prevent further coagulation. But before that, they will have to be tested for protein deficiencies and other disorders that can contradict with the medicines.
Physical activity is also encouraged unless clinically difficult. Blood flow is increased during physical activity, preventing stagnation and formation of blood clots.
Thrombolysis
An enzyme which breaks up blood clots is introduced into the body or injected directly to the damaged vein in thrombolysis. This method is believed to reduce risk of post-thrombotic syndrome and leg ulcers. However, it minimally increases risk of bleeding.
Anticoagulants are more preferred over thrombolysis. But patients may opt for the latter if the risk of post-thrombotic syndrome is higher than risk of bleeding, and cost, and complexity of the procedure.
Diet and Lifestyle Changes
As soon as you are diagnosed with any vein disease, it is important to make dietary changes immediately. Seek the advice of a licensed dietician to come up with a meal plan that suits your overall health, particularly if you have other health conditions.
Smoking, drinking, and unsupervised drug use should be prevented.
Elevating your legs once in a while can also assist blood movement towards the upper part of the body.
The support of family and friends are also vital in the treatment of vein disease.