By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
Venous insufficiency is a disease where a vein fails to work properly and becomes congested, distended and results in varicose veins. In venous insufficiency, it is usually veins in the superficial system that fail but even though they are called “superficial,” they often are not visible to the naked eye. The veins that can be seen are usually what are known as “tributary” veins. The visible veins are not always the veins that cause physical symptoms and sometimes can just be an indication of deeper disease. That is why a duplex mapping ultrasound is necessary in order to treat the disease properly.
True varicose veins are veins that are dilated greater than 3 mm and have more than 0.5 seconds of blood flowing backwards. Veins that are 1 mm to 3 mm in diameter are known as reticular veins and veins less than 1 mm are called telangiectasia veins. Research supports that the veins that meet criteria for varicose veins are the ones most likely to cause physical symptoms which include leg fatigue, aching, cramping, restlessness, rashes, swelling or even ulcerations. That is when the veins need to be treated. Just having a bulging vein is not an indication for treatment.
When a vein becomes a varicose vein, it is not working correctly. Blood flows backwards towards the toes instead of being circulated back to the heart and lungs to be re-oxygenated and exchange nutrients. The stagnant blood in these engorged veins is much more prone to developing blood clots and the tissues surrounding the vein do not get the oxygen and nutrients needed to stay healthy. The body also will sense that the vein is not working properly and will grow new veins to replace the diseased vein. This is known as angioneogenesis.
The way veins are connected is not simply that one drains into another, like a pipeline. Instead each vein has many veins that branch off it, more like a tree root system. When a vein becomes diseased, the way it is treated is to destroy it or remove it. This immediately forces the blood to be directed into the healthier veins. Sometimes the healthy veins are no bigger than a strand of hair.
When a duplex mapping ultrasound is done, the deep venous system is evaluated to see that the veins are all open and working correctly. These are essential veins and are never destroyed. The superficial system then is “mapped out” and the larger veins are measured for size in millimeters of dilation and also how long in seconds the blood is flowing in the wrong direction. The superficial system includes the veins you can see on the surface as well and the veins underneath that you can’t see that connect into the deep system. None of those vessels are essential and any of them can be treated to improve the blood return to the heart.
In order to treat the disease correctly, the largest, most diseased veins need to be treated first. This usually decreases the pressure in the surrounding vessels and the treatment of the visible veins then is much more effective. Other times, the surrounding branches become larger and more visible. The blood flow will take the path of least resistance and sometimes that is through another diseased vein which may not have had that amount of blood flowing through it initially. When a vein is treated, it is destroyed or rendered non-functioning. This forces the blood immediately through other veins restoring blood return to the heart.
Treating venous insufficiency is a process not just a procedure. It often takes several procedures and they may be different types of procedures. By using a step wise approach to treating venous insufficiency, the least number of veins will be treated with symptom control being the indicator for successful treatment. Venous insufficiency is a disease. Whatever the reason for a person developing venous insufficiency is usually still a part of them and even though it is treated, it doesn’t mean other veins will not go bad in the future.
Just because a vein is visible, it isn’t necessarily diseased and it isn’t always the problem. It may just be an indication that there is underlying disease that does need to be treated. A thorough evaluation is necessary to diagnose the disease and determine what treatment would be indicated. Please contact us at (814) 515-9919 and schedule for an evaluation if you think you may have venous insufficiency.