By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
The symptoms resulting from diseased veins can also be symptoms caused by other disease processes. Sometimes it is not possible to determine what is causing the symptoms specifically so treating the veins is actually like having a test done. If the symptoms go away after treatment, then we know the veins were causing them. If the symptoms persist, then we know that the veins were not causing them. To treat veins, they have to meet certain criteria of being diseased so treating the veins is not wrong, those veins were not healthy or functioning correctly. If the symptoms are coming from other disease processes, they will persist.
Symptoms that develop from venous insufficiency are a result of the chronic over dilation of veins which causes the loss of integrity of the vein wall. When the vein walls lose their integrity, they cannot prevent the leakage of fluid, red blood cells, proteins and nutrients into the tissues. Once these substances are in the tissues, the body must rely on other body systems to remove them.
The body will sense that there are substances in the tissues that are not supposed to be there. This triggers an inflammatory response sending other cells to the area to break down and reabsorb the substances. This microscopic inflammation is not something that you will be able to sense as pain or discomfort, but over time causes normal tissues to develop fibrous deposits. These fibrous deposits are like microscopic scars and when enough deposits are present, they will cause normal soft, supple tissues to turn into harder, less elastic tissue. These deposits can develop in the fat cells, connective tissues and skin cells. This presents as dry skin, skin rashes, hard skin that resembles leather or even pitted like an orange peel and eventually skin ulcers. Tissue that becomes more fibrous will also not stretch like normal tissue and when swelling occurs, it will occur above and below the level of fibrous tissue but not the fibrous tissue itself. These symptoms develop only after many years of untreated diseased veins and in most cases cause permanent changes in the tissues and skin. Treating the veins will not reverse this damage but may prevent it from becoming worse.
Blood cells that leak into the tissues are also broken down by this same inflammatory response but it is more difficult for the body to breakdown blood cells. There is a component of the red blood cell called hemosiderin that is extremely resistant to breakdown. This is the part of the red blood cell that carries the iron. It is often left behind after the rest of the red blood cell is broken down and the iron eventually discolors leading to a permanent brown discoloration of the skin. The hemosiderin that is left in the tissue leads to a chronic inflammation as the body does not like it there. This further contributes to more fibrin formation in the tissues. Treating the veins will not reverse this discoloration, but may prevent further discoloration from occurring.
Fluid that is in the tissues does not “leak” back into the veins, but instead relies on the lymphatic system to filter it out to be eliminated by the kidneys. The lymphatic system can become overwhelmed and can’t keep up with the excess fluids leaking out of the veins leading to chronic swelling. If the swelling is only from the diseased veins, treating the veins will decrease the swelling. But if the swelling is from other causes like damage to the lymphatic system, congestive heart failure, kidney disease or injury, treating the veins will not resolve the swelling. Sometimes the cause can be mixed between the diseased veins and other causes, in that case, treating the veins will improve but not eliminate the swelling.
Veins and nerves live in very close proximity and when the veins are inflamed from damage, often irritate the nerves that are close to them. This can cause symptoms that mimic restless leg syndrome or neuropathy. If restless leg syndrome and neuropathies are present from damage to the nervous system and not from the inflammation in the veins, treating the damaged veins will not make those symptoms go away. Treating the veins may make those symptoms easier to control or respond to treatments more effectively.
In venous insufficiency, blood is not being returned to the heart in an effective manner. The veins become congested and the blood in them becomes stagnant or trapped. The body will continue to use all the nutrients and oxygen in this blood until it runs out. This decreases the supply of oxygen and nutrients to the skin making symptoms such as dry skin, skin rashes or skin ulcers worse. The trapped blood is also not flowing like it should and is more prone to developing into blood clots which can be a serious consequence of untreated venous insufficiency.