To understand the causes of venous disorders, you have to start with the circulatory system. Our circulatory system is made up of two separate parts: arteries that take the blood from the heart to all the tissues in our bodies and veins that return the blood back to our heart. The arteries benefit from gravity, which pulls the blood downward from our heart, whereas the veins have to generate their own pumping action to resist gravity and move the blood back up to our heart. To move the blood in this way, our veins are arranged in two layers: deep veins that run vertically within our muscles and superficial veins that are arranged as a network of thousands of vessels. When the veins are unable to pump blood properly, blood begins to pool in our veins instead of moving upward toward our heart. This pooling is what leads to the appearance of spider and varicose veins as well as the more serious symptoms for leg pain, leg swelling, and blood clotting.
What happens if I don’t treat my varicose veins?
There are several adverse consequences of untreated varicose veins, and their severity will vary from person to person depending on their circumstances. Many people who don’t treat their varicose veins will experience continued symptoms of pain, fatigue, and swelling of the legs or ankles. More advanced medical problems can include hyperpigmentation, lipodermosclerosis, venous leg ulcers, spontaneous bleeding, superficial thrombophlebitis, and a potentially life-threatening condition called deep vein thrombosis. If you’re unsure of the severity of your varicose veins, you should see a vein care specialist, who will be able to determine the severity of your condition and whether treatment is necessary.
Blood that pools in the varicose veins is depleted of oxygen and nutrients. The veins also do not tolerate high pressure well and begin to allow red blood cells and fluid to leak into the tissues of the leg, which causes painful swelling. The red blood cells in the tissues cause chronic inflammation and the skin becomes dark and discolored. The medical term for the dark discoloration is hyperpigmentation. When the skin and the fat under the skin are inflamed for years, the tissues become woody and firm. The medical term for this woody, hard tissue is lipodermosclerosis.
A condition that may occur over time, when there is chronic venous insufficiency, is a venous leg ulcer. The ulcers due to varicose veins are painful and difficult to heal. Sometimes the ulcers cannot be healed until the backward blood flow in the veins is corrected.
Another possible consequence of untreated varicose veins is spontaneous bleeding from the varicose veins. As the skin over the veins becomes thin, eventually the vein can be exposed to the outside world and be easily injured by clothing, bedding, etc. The blood loss can be significant and is painless.
Superficial thrombophlebitis (ST) is an inflammation of a vein just below the surface of the skin. The cause of inflammation is not an infection. Rather, inflammation is due to decreased blood flow through the vein, damage to the vein and blood clotting. The features of ST include redness to the skin and a firm, tender, warm vein. Localized leg pain and swelling may occur as well.
Deep vein thrombosis (DVT), unlike ST, can be associated with significant and serious medical problems. DVT is often first noticed as a “pulling” sensation in the calf of the lower leg, and it can be quite painful. Symptoms also include associated warmth, redness, and swelling. The swelling often extends to above the knee. Some patients are at higher risk for developing DVT. These include people with one or more of the following characteristics:
- Over 60 years of age
- Recent surgery
- History of prior DVT
- Prolonged immobility/paralysis
- Blood Clotting Disorders
- Pregnancy and Postpartum
When a diagnosis of DVT is made, anticoagulation treatments are often started. Anticoagulation prevents progression of the blood clot, breaks up the clot and prevents the clot from traveling to the lungs. If a clot travels to the lungs it is called a “pulmonary embolus” and the outcome can be fatal.
If you’re not sure whether you need to treat your varicose veins, see a vein care specialist for a consultation. A specialist will be able to evaluate your condition and determine what kind of treatment is needed.