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The term phlebology refers to the study of disorders that affect the veins (Greek: phlebos = vein, blood vessel). Based on a survey of the World Health Organization (WHO), vein problems rank among the most common diseases worldwide. Venous leg disorders are some of the earliest documented illnesses suffered by mankind. They can vary greatly in severity, and only very few people are completely symptom-free.
Venous disorders may manifest with only mild symptoms, such as a feeling of heaviness in the legs. Other affected persons may suffer from pronounced venous dysfunction with severe impairments. Often problems arise when they could perhaps have been avoided, due to lack of knowledge about the functioning of the body. Venous disorders should always be taken seriously and any early signs, such as spider veins, should be diagnosed and treated as soon as possible.
- 5 litres of blood are pumped through our bodies every minute
- 65% of the total quantity of blood in the body is located in the veins
- Of the 4,500 litres of blood transported daily out of the legs and back to the heart, 90% is transported by the deep major veins, and 10% by the superficial veins
- The most important superficial veins are the great saphenous vein and the small saphenous vein
The cardiovascular system of our body is very complex and we are all aware that the heart plays a fundamental role in it. The fact that the leg veins, however, have an extremely demanding task to perform day in, day out, is not known to many people. The veins in the legs must return the blood from the lowest point in the body back to the heart, against gravity and without any breaks – 24 hours a day, throughout our entire life.
The “skeletal-muscle pump” of the leg muscles, also referred to as the “calf muscle pump”, performs the most important function in returning the blood to the heart. Every time we move our legs (e.g. while walking), we tense the muscles in the lower leg which then function like a natural pump, push the venous blood out of the legs and back up to the heart.
Even the smallest changes to a vein, for example when it becomes dilated, can have a negative impact on the functioning of the venous valves so that they will no longer be able to close properly. This can cause the venous blood in the veins to accumulate and only flow slowly. This blood stagnation is initially perceived as “heavy” or “swollen” legs. If these symptoms are left untreated, however, they can lead to further, more serious illnesses.
Dysfunction of the leg veins are caused by impaired blood flow and can manifest in different degrees of severity: from minor impairments to disorders that can be life-threatening if not detected.
The predisposition to varicose veins usually runs in the family. The cause is a congenital weakness in the walls of the veins. If you suffer from varicose veins, it is possible to limit or delay their spread through effective treatment measures such as, for example, compression therapy. This condition cannot, unfortunately, be cured by medication, although medication can be a valuable supplement to other therapeutic measures.
A varicose vein refers to a dilated vein in which the venous valves have ceased to function properly.
As a result, the blood can no longer be optimally transported back to the heart. It collects in the legs due to gravity, thereby leading to blood congestion. The pressure in the veins increases, which causes the vein walls to stretch and the veins to bulge out. The dilated vein becomes tortuous and knotty. It may become visible on the surface of the skin and produce a tangible bulge.
Varicose veins should never be regarded as a purely cosmetic problem.
If left untreated, they can cause severe leg complaints and disorders, for example inflammation of the veins or tissue damage. Early detection can help to avoid such complications.
Fig. 1 (left): Normal vein: the venous valves prevent the blood from returning into the legs.
Fig. 2 (right): Varicose vein: due to the dilation of the vein, backflow of the blood through the venous valves cannot be prevented.
There are two types of varicose veins:
- Primary varicose veins: Approx. 80% of all varicose veins. This type is caused by a congenital weakness in the vein walls or insufficiency of the venous valves.
- Secondary varicose veins: Usually develop after leg vein thrombosis. This type is caused by many years of excessive strain on the surface veins due to blood stagnation.
Thromboses arise as a result of a clotting disorder of the blood. When the blood suddenly clots in the vascular system, a blood clot (thrombus) can form on the vessel wall. This kind of blood clot usually forms in the veins – in particular in the deep leg veins. These deposits constrict the vessels or can even block them completely. The blood can no longer flow optimally through the veins to the heart. This is then referred to as a deep vein thrombosis.
The symptoms can vary widely and do not have to all occur together. That is why a deep vein thrombosis is not always easy to recognise. Look out for the following
warning signs on your legs:
- Pain on exertion, in particular while walking, standing or sitting
- Discolouration or glossiness of the skin (reddish or blueish)
- Feeling of tightness
- Sensation of warmth in the affected limb
- Sudden appearance of veins on the surface (e.g. a “warning vein” over the shin bone)
When a blood clot forms in the superficial veins, this is usually accompanied by inflammation. One possible symptom of a superficial vein thrombosis is hardening or reddening of the affected area. Tenderness may also arise.
If you suspect the presence of a thrombosis, you should consult a doctor immediately! Often a thrombosis will initially not be accompanied by any symptoms at all, and therefore not be recognised in a timely manner. A pulmonary embolism could potentially form.
A common trigger for a pulmonary embolism is a deep vein thrombosis that went unnoticed. A blood clot breaks loose from the vein wall, either fully or parts of it, and then slowly moves through the bloodstream until it reaches a narrow blood vessel and becomes lodged there.
A blood clot can also be carried along through the heart and into the lung. The pulmonary arteries branch many times within the lung and become successively smaller in diameter.
As a result the clot gets stuck in one of the narrow arteries and the vessel becomes obstructed. The affected area of the lung can no longer be adequately supplied with blood. If only a small artery in the lung is involved, the person will often experience no symptoms or only minor ones. If the blood clot blocks off a large vessel, however, this can be life-threatening.
Some of the key symptoms of a life-threatening pulmonary embolism are:
- Difficulty breathing
- Sudden shortness of breath
- Coughing up blood
- Rapid heart beat
- Sudden loss of consciousness
Should you notice one or more of these symptoms, please see your physician immediately!
Venous leg ulcers
Venous leg ulcers are poorly or sometimes non-healing wounds on the lower leg or foot. They often develop as a result of a long-standing and untreated weakness of the veins.
The skin ulcerations, which are most commonly found above the medial malleolus, form due to constant and persistent congestion of the veins. This puts a continuous strain on the blood vessels which are subjected to strong pressure. The tissue in the affected area is then only poorly supplied with oxygen and also unable to adequately transport away the waste products. In the end, this imbalance manifests itself on the skin and the underlying tissue. The skin becomes thinner and thinner until finally an open, painful wound develops.
There is no one single cause for vein problems. In most cases they arise as a result of a combination of factors. Venous dysfunction often manifests itself in the beginning as small changes in the leg, for example spider veins or reddening of the skin. If you listen to your body, you will notice these symptoms and hopefully avoid a more serious illness.
Generally speaking, you should try to reduce or avoid the following risk factors that can contribute to the onset of vein problems:
- Excess weight
- Lack of exercise (frequent sitting and long periods of standing)
- Nicotine and alcohol consumption
- Hormonal influences (e.g. the contraceptive pill)
- Tight, constricting clothing
- Extreme exposure to heat (excessively hot baths, saunas, intensive sunbathing)
- Shoes with high heels
Results of the Bonn Vein Study*:
- Approx. 90% of the average adult population exhibit signs of venous system abnormalities
- Only less than 10% of the population show no signs of vein impairment
- Approx. 60% exhibit at least spider veins as a sign of vein impairment
* 2003 Bonn Vein Study of the German Society of Phlebology, 3,072 male and female subjects between the age of 18 and 79. The study results are based on the German population.
Weakness of the veins and connective tissue
Vein problems are very often inherited, and some patients will be predisposed to them from birth. In almost all cases, the parents and grandparents are found to be afflicted by varicose veins.
The vein walls can be overly elastic, which makes them weaker and can give rise to premature dilation of the veins. Unfortunately, this congenital weakness of the connective tissue cannot be corrected, however it is possible to prevent a worsening of the condition using compression stockings.
During the course of our lives and as we get older, the connective tissue gradually becomes more lax and the vein walls weaken and “bulge out.” That is why it is ever so important to treat your legs well and support your veins as much as possible.
Venous insufficiency affects women more frequently than men. That is why you should start looking after the health of your veins from a young age. Wearing shoes with high heels, for example, hinders the movement of the ankle. This adversely affects the muscle pump causing the blood to accumulate.
Hormonal influences such as the contraceptive pill or the changes to the body during pregnancy place women at increased risk of venous disorders.
Pregnancy: The body in an exceptional state
Pregnancy places great demands on a woman‘s body. Up until the birth of the child, the blood volume in the mother increases by 30–40%. This is very taxing on the veins.
Furthermore, the hormones released in the body soften the connective tissue to prepare the body for the changes to come. This also has the effect of making the vein walls more elastic and they can lose their tension.
The growing uterus also presses on the inferior vena cava. The inferior vena cava is the largest vein in the body and carries blood from the lower limbs, parts of the pelvis and from the abdominal organs. Pressure on this vein impedes the return flow of blood from the legs, thereby increasing the risk of spider veins or varicose veins.
Pregnant women are therefore advised to counteract this risk through activity and regular exercise. Many pregnant women complain of “swollen legs”, especially in summer. Don‘t be afraid to take a break now and then and elevate your legs. Your body will thank you for it.
Compression stockings also provide alleviation and relief for heavy and swollen legs. They can be worn for the entire duration of the pregnancy and you can start wearing them from early pregnancy onwards. This will help you enjoy your pregnancy to the fullest!
Long journeys: difficult times for your legs
If you travel often and for long distances, then you may be familiar with the feeling of swollen and heavy legs. This is not only uncomfortable, but could actually turn out to be hazardous to your health.
A traveller‘s thrombosis, also referred to as “economy class syndrome”, could develop.
Long periods of cramped seating, bent legs and lack of movement during a trip can get dangerous, especially for people who belong to particular risk groups. Fluid can accumulate in the legs and, by putting pressure on the tissue, hinder the return flow of blood. In rare cases, a blood clot – referred to as a thrombus – forms on the wall of the vein and blocks the vessel.
The high-risk groups for traveller‘s thrombosis include older or overweight people, people with a previous history of thrombosis or embolism, pregnant women, patients with varicose veins or pre-existing vein problems and people with a congenital blood clotting disorder.
It is advisable for both women and men to wear compression stockings during longer trips to relieve the veins and also prevent the accumulation of fluid. A below-knee stocking can be sufficient to provide relief. You should also get up and move every now and then during the trip as well as keeping well hydrated.
The symptoms of a possible venous disorder can be categorised into internally experienced symptoms and externally visible symptoms. You can use the signs in the following lists to identify whether you are potentially suffering from a venous disorder. If you notice one or more of the following signs of venous insufficiency, please consult a doctor.
Symptoms that are visible on the outside
- Swelling, especially in the ankle and foot
- Spider veins
- Varicose veins
- Reddening or other skin discolourations
- Dry, thin skin over the affected vein
- Skin ulcerations in the ankle area
Internally experienced symptoms
- Tired, heavy or painful legs
- Calf cramps at night
- Stabbing or dragging pain in the calves
- Tingling or burning
- Tenderness, feeling of tightness
Always consult a doctor if you notice any changes in your veins. Your doctor will perform an in-depth consultation and provide you with information on suitable treatment methods. We can only provide you with information on the most common treatment methods here. You doctor will discuss further options with you. Venous disorders cannot be cured with medication alone. Treatment can however be usefully supplemented through the use of additional medication.
Compression therapy is an important component and often the first choice in the treatment of vein problems. While compression cannot reverse pre-existing spider veins or varicose veins, it can prevent these conditions from worsening. Consistent compression therapy is essential in the more advanced stages of these disorders.
Compression stockings exert an optimal pressure gradient that gradually decreases from bottom to top. This supports the return flow of blood, as the external pressure on the dilated vessels reduces the diameter of the veins and improves the efficiency of the skeletal-muscle pump. This helps the valves in the veins to close better, thereby reducing blood stagnation in the legs, or even preventing it entirely if the venous valves are still intact. The blood flow to the heart is improved as a result.
Compression can also support the treatment of severe conditions. It can alleviate the symptoms of a thrombosis, and reduce the frequency and severity of chronic venous insufficiency.
If your occupation requires you to stand or sit a lot, compression stockings can have a very beneficial effect on your legs and also protect them against vein problems. They provide noticeable relief to the legs.
Your physician will prescribe the right compression class for your needs, as there are different compression strengths (from light to strong compression) available depending on the severity of the symptoms and the particular application. When undergoing compression therapy, it is very important to wear the stockings consistently and ensure they fit perfectly.
Your medical products supplier will therefore measure up your legs to determine the appropriate size for you, or arrange for the manufacture of a custom-made stocking.
An appealing look is of importance too. Modern compression stockings not only provide support for your legs, they also look great and are pleasant to wear – for both women and men!
They are available in a variety of styles, from below-knee stockings to pantyhose. They also come in a wide selection of colours for perfectly matching them to any outfit.
Obliteration of varicose veins (sclerotherapy)
Sclerotherapy is recommended for gently removing spider veins or small varicose veins. This treatment method is considered to be very safe and has few side effects, but it usually requires several sessions.
A sclerosing agent is injected into the relevant dilated vein. This irritates the vein wall and induces an artificial inflammation of the vein, which in turn causes the vein walls to stick together and seal shut. The body then breaks down the vein in a matter of weeks leaving no scar. As the predisposition to varicose veins still remains, it is necessary to repeat the sclerotherapy treatment every one to two years.
Larger varicose veins are usually treated surgically. The most common method used is vein stripping. Stripping involves tying off the vein in such a way that the blood can no longer flow from the deep vein to the superficial venous system to stagnate there.
The vein is then cut through below the varicose vein. The defective section is removed from the leg through an incision in the groin area with the aid of a probe. Healthy vein segments are normally retained in the leg.
Further varicose veins may form at a later time, but these are usually less severe than before the operation.
What you can do for yourself
There are many things that you can do to positively support your veins and their health, and to prevent venous disorders.
Did you know? Your body is designed to walk 30 km a day. How many kilometres do you actually do? No one expects you to walk a half marathon every day, of course. But even smaller walks can make a difference to your health.
Pay special attention to the avoidable risk factors. In addition to reducing or avoiding these risks, you should also take active measures as well: why not take the stairs instead of the lift every now and then, or the bicycle instead of the car.
Forms of exercise that improve your endurance, for example swimming, cycling, walking or jogging are ideal for strengthening your muscle pumps. Your body will thank you for it!
Refrain from crossing your legs as this can constrict the veins at the back of the knee, thereby restricting blood circulation. Instead, cross only your feet when sitting.
A healthy diet is always advisable as every extra pound puts further strain on your body, in particular your legs and veins. Make sure your dietary fibre intake is sufficient and cut down on sugar and fat. You should ideally also avoid alcohol and nicotine consumption.