What can go wrong with the Great Saphenous Vein (GSV)?
There are two main things that can go wrong with the superficial veins of the legs:
blood can clot in the veins causing a thrombosis
the valves can fail, allowing blood to “reflux” back down the vein the wrong way causing venous incompetence
These will now be explained in more detail.
1 – Blood clot (thrombus) in the Great Saphenous Vein (GSV) -:
When blood clots in a superficial vein, it causes a condition called “superficial thrombophlebitis“.
This medical term can be broken down into its constituent parts:
“superficial” means that it is occurring in veins outside of the muscle and just under the skin or in the fat
“thrombo” means that the blood has clotted causing a thrombus
“Phlebitis” means that the vein has become inflamed around the thrombus
It is a normal part of the healing process for the vein to become inflamed around the thrombus within it. Inflammation is nature’s way of healing. It makes the vein go hot, red, swollen and painful. At the microscopic level, this means that lots of white blood cells are attracted to the area, which eat away at the thrombus and repair the vein.
It is unfortunate that many doctors and nurses who do not understand venous surgery think that the hot, red, swollen and painful vein affected by thrombophlebitis is infected. As the body’s reaction to infection is also inflammation, to the untrained eye it can be difficult to differentiate between the two. However if the cause of the information is a superficial vein that has now become hard and tubular, it is fairly obvious that it is a thrombophlebitis and not infection.
This becomes very important when treatment is considered.
2 – Valves failing in the Great Saphenous Vein (GSV) causing venous reflux and venous incompetence
Valves are essential in the veins in the legs to stop blood falling the wrong way down the legs due to gravity when standing and walking. In certain families, the valves are more likely to stop working, showing there is truth in the saying that “varicose veins run in families”.
In the Great Saphenous Vein (GSV) this venous incompetence is particularly important. Not only is the Great Saphenous Vein (GSV) the longest vein in the leg, but there are no other valves in the deep veins above the Great Saphenous Vein (GSV) all the way up to the heart. Therefore if the valves have failed in the Great Saphenous Vein (GSV), when the patient stands, blood can fall from the heart all the way to the ankle.
This can either stretch veins that come off the side of the Great Saphenous Vein (GSV) – a condition called ‘varicose veins’ – or can cause inflammation and damage in the capillaries which can cause swelling of the legs, tenderness and tiredness of the ankles, red or brown patches around the ankles, venous eczema on the inner aspect of the ankles or, if left long enough, venous leg ulcers.
This is called “Phase 2 Passive venous reflux” and is described fully in The College of Phlebology book “Understanding Venous Reflux – the cause of Varicose Veins and Venous Leg Ulcers”.