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Varicose Veins

Varicosis or Varicositas (from “varix, pl. varices“, lat.: knot), commonly known as Varicosity or Varices, is among the most-common diseases in Western society. According to studies, about 40 percent of the population are more or less afflicted by a dilation of leg veins.

Varices are not only a visual problem

VaricesVarices do not just constitute a visual problem but may also cause various disorders like “heavy legs“, itching, prickling – and furthermore lead to inflammation of the veins (thrombophlebitis), leg ulcer (ulcus cruris) or even cause blood clot in the deep leg vein (thrombosis), risking pulmonary infarction.

A disease of the veins

Varicosity is an affliction of the veins – those blood vessels which transport our blood back to the heart. Contrary to arteries, veins are tender, sometimes even flimsy, vessels.

Anatomy

AnatomyVeins of the leg are classified into the deep venous system (guide veins), veins being on the muscles (trunk veins), veins in the subcutaneous adipose tissue (lateral branches) and into the bluish vessels directly beneath the skin (reticular veins).

The larger trunk veins are the Vena saphena magna and the Vena saphena parva. These are the veins which quite often suffer from varicosity.

The various vein systems are interconnected like a network. In addition connecting veins (perforating veins) communicate the deep veins with superficial veins – about 200 in each leg.

Blood in the vein has to flow in direction of the heart against the force of gravity. Thereby venous valves prevent the flowing back of the blood. The venous valves are to be found in each vein every 8–10 cm (3–4 inches) apart, whereby the largest venous valves are found in the groin and in the hollow of the knee (mouth valves).

How comes varicosity about?

Venous ValvesOwing to our upright walking the veins have to bear heavy pressure. That causes dilation of the thin vein walls, and in the course the venous valves cannot close anymore. The blood sinks into the legs, which often feel heavy. That leads to chronic inflammation and within years to phlebitis and discoloring of the skin. If untreated, open leg (ulcus cruris) may develop after years.

Aggravating factors in terms of venous afflictions include also our modern way of living: Sitting position, little movement, overweight, poor diet and nicotine.

Classification

Varicose veins (varices)Varicose veins (varices) may appear in various forms. They vary from tender bluish or reddish reticular veins (spider-burst) within the skin to thick, restiform trunk varices, partially about the surface of the skin. This is a symptom of an advanced venous disease, with the venous valves inoperative to some extent.

Spider Veins

Tender, unaesthetic vessels, bluish or reddish, arranged individually or also extensively about the legs, sometimes including painful alterations in the skin.

Reticular varices

Reticular varicesThese represent a light form of varicosity. Extended bluish veins just under the skin. The normal delineation of veins should not be mistaken for the often sidled, large bluish reticular veins.

Varicosis of lateral saphenous branches

Varicosity ranging from light to severe forms confined to the lateral branches.

Trunk varicosis

StammvarikositasVaricosity ranging from light to severe forms involving the large venous valves in the groin or in the hollow of the knee, in most cases involving also abnormal dilation of the lateral branches. In cases of segregated trunk varicosis, flowing back of blood incurs, from the venous valves, whereby however the lateral branches are not dilated.

Late onset of treatment

After years of retarded varicosity, a patient visited an outpatient hospital clinic. The varicosity had led to severe alterations in the skin (dermatoliposclerosis) by the formation of ulceration in the lower leg (ulcus cruris) and an overload in the deep veins of the leg (chronic venous insufficiency).

Timely onset of treatment

Widespread varicosity. Yet the patient could still be operated scarless by minimal-invasive techniques under local anesthesia (tumescence anesthesia).