The following is a statement from Pravin M. Shah, MD, FACS, Professor of Surgery, New York Medical College:

Do your legs ache or feel heavy especially at the end of the day or during the second half of your menstrual cycle? Are you embarrassed to wear a bathing suit or show your legs in public because of unsightly veins on your legs? Has pregnancy left you with unattractive blue bulging marks on your leg? If the answer to any of the above questions is yes then most likely you may be suffering with venous reflux disease.

Veins are series of pipes in the body that bring the blood back to the heart. So when we are standing, blood from the leg has to travel against gravity to reach the heart. In the legs there are two sets of veins. One is a superficial vein and the other is a deep vein. As the name implies, superficial veins are the veins we see under the skin and deeper veins are situated deeper in the leg and are covered by muscles. Two main superficial veins are greater and lesser saphenous veins. The superficial veins connect to the deep systems. Normally blood returns back to the heart by flowing upward against gravity in both superficial and deep systems of the veins. Blood also flows one way from the superficial to the deeper system. There are multiple one-way valves in a vein that make this flow possible.

Venous reflux disease is a disease that results from the damaged vein valves. With the damaged valves, the blood in the veins flows in the wrong direction resulting in venous congestion and varicose veins in the leg.

When we walk, a pumping action of the calf muscle facilitates an upward movement of the blood in the vein. One-way valves at the multiple levels in the vein facilitate movement of the blood against gravity. One of the most important valves in the vein, near the groin, is called saphno-femoral valve. This valve is at the junction between the greater saphenous vein (superficial vein) and the femoral vein (deep vein) and prevents blood going to the superficial system from the deep system. When valves in the vein are defective, the blood leaks (venous reflux) and instead of moving upward towards the heart, blood pools down in the leg causing venous stasis (venostasis) or venous congestion. Over the course of time the vein and its branches (tributaries) in the leg enlarge to become prominent bulges and ultimately awful-looking varicose veins. When a vein abnormally dilates, its valves become incompetent and create a vicious circle. Hormonal changes during the menstrual cycle aggravate the situation.

The symptoms of venous congestion and venous reflux vary from mild discomfort to ugly-looking veins, severe pigmentation and ulceration of skin. It is unfortunate that many women suffer silently from symptoms of venous reflux disease. The dull aching pain, heaviness, and fatigue (especially at the end of the day) relieved by elevation of legs, are accepted as normal. On the other hand many young women go through life feeling self-conscious and are embarrassed to go to the beach or attend pool parties because of the presence of unattractive veins on the legs.

Diagnosis of venous reflux disease is easily made by a physician during a clinical examination and confirmed by a non-invasive ultrasound examination.

Once the diagnosis is made the treatment can be as simple as wearing medical grade support stockings to minimally invasive endovenous ablation of veins to prevent flow through leaky valves. This will prevent any congestion in the leg.

Vascular Associates of Westchester

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