By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
Varicose veins are veins that are over-dilated and measure more than 5 mm in diameter. They have blood flowing in the wrong direction which results in high pressures making the dilation worse and prevents efficient return of blood to the heart. So the easy answer to the question of whether treatment is necessary or not is that the veins will continue to get worse without treatment. They will not go away on their own. But more importantly, untreated varicose veins can cause significant health problems and affect the quality of life.
When veins become over dilated, the vein wall loses the ability to keep blood contents inside the veins. Fluid and nutrients leak out through the vein walls into the tissues. These substances are not meant to be deposited there and the body will sense that. This leads to swelling and a microscopic inflammation that in the beginning, you will not notice. When enough fluid accumulates in the tissues, the body relies on the lymphatic system to filter this fluid and eliminate it from the body. When the lymphatic system can’t keep up, this is when you notice swelling. The nutrients that are deposited in the tissues trigger an “inflammatory” response so these substances will be broken down and reabsorbed. This microscopic inflammation is generally not something you are able to notice on a day to day basis. After years of inflammation, vessel walls, connective tissues, fat cells and skin structures start to turn more fibrous or scar like. This will result in tough, leathery skin that has less ability to stretch and sometimes causes the legs to appear miss-shaped.
The body is able to grow new blood vessels from any vessel in the body. When the body senses that a vein is not functioning correctly, it will start to grow new vessels to take over for the vessel that isn’t working right. Sometimes these fragile, new vessels are put under high pressure trying to compensate for the work of the diseased vessel and they rupture. When that occurs, blood cells are released into the tissues. This also triggers an inflammatory response and the body will break down the blood cell and it is reabsorbed. There is something called hemosiderin, which is the part of the red blood cell that carries iron. It is much more difficult for the body to break this down and reabsorb it so it is often left behind in the tissues. It’s presence in the tissues is irritating and results in a chronic microscopic inflammation that can be persistent for years. This makes even more fiber develop in the tissues making the scar or fiber formation worse. Lastly, the iron that is attached to the hemosiderin will eventually “rust” causing permanent brown skin discoloration.
When blood is not being returned to the heart and lungs to get more oxygen and nutrients, the tissues surrounding these diseased vessels do not get the oxygen and nutrients they need to stay healthy. People often notice dry, scaling skin in the areas surrounding varicose veins that can lead to long lasting skin irritation, itching and even wounds that are very difficult to heal.
The blood that is not being returned to the heart becomes trapped in the vessels and has a higher chance of becoming a blood clot. When superficial veins become inflamed, it is called “phlebitis.” When the superficial veins develop a blood clot which triggers the inflammatory response, it is called “superficial thrombophlebitis.” This can happen over and over again depending on the health status of the person and the health of their veins. Most of the time, as long as the blood clot stays in the superficial vein, it is not necessarily dangerous. It is painful and annoying, but it is the body’s way of destroying a diseased vein. In other cases, it can become life threatening if a superficial blood clot moves into the deep system.
Varicose vein disease may also make other conditions like neuropathy or restless leg syndrome worse. Nerves and veins are located side by side in the legs so when the veins are dilated and inflamed, they often irritate the nerves making nerve conditions worse.
Symptoms most often associated with varicose veins include swelling, heaviness in the legs, aching, leg fatigue, skin rashes, itching and pain. Without treatment of the diseased veins, these symptoms will continue to get worse and worse, eventually limiting activity and the ability to function.
If you think you have this disease, please contact us to schedule an evaluation.