Varicose Veins - Symptoms

Symptoms of varicose veins

The word "varicose" means a dilatation and therefore varicose veins are dilated veins.
 
In the simplest cases, varicose veins can be seen as bulging veins in the legs when the patient is standing up. When lying down, the vein is empty and they 'disappear'. These veins are often blue or green if they are close to the skin's surface, although they can be skin coloured if they are deep and have a good covering of skin.
 
Before we had the sophisticated duplex ultrasound scanners that we have nowadays, doctors and nurses were quite happy to diagnose varicose veins when they saw this lumpy veins of the legs and similarly to say that someone did not have varicose veins if they did not see these lumpy veins on the surface. However through the use of duplex ultrasound machines, we have a much deeper understanding of varicose veins. 
 
Varicose veins - Small Saphenous Vein (SSV), pelvic veins and perforators on the back of the calves
 
With duplex ultrasound we are able to see the flow of blood within the veins without needles or piercing the skin at all.  With this technology we can see that some people with bulging veins actually have normally functioning veins, and the veins just look like they are bulging because there isn't much body fat. Of course most people who see bulging veins on the surface do have varicose veins and in these patients, duplex ultrasound can show that blood is flowing the wrong way due to the valves in the veins not working properly.
 
However, much more interestingly, many people whose legs look normal but who have one or more of the following:
  • aching of the legs
  • swelling of the ankles
  • thread veins of the legs
  • red or brown patches around the ankles
  • itchy skin around the lower legs or ankles
  • leg ulcers
actually turn out to have the same problem of the valves in the veins not working and blood flowing the wrong way down the veins on standing, even though there are no varicose veins visible. When this happens,
it is medically called "venous incompetence" or "venous reflux disease" but we find it much easier to understand for patients if we call it "hidden varicose veins".
 
In addition to these symptoms and signs, blood falling down the veins the wrong way can clot, causing inflammed painful lumps called "phlebitis" or "superficial thrombophlebitis". Also, if the veins rupture, then varicose veins or "hidden varicose veins" can bleed profusely. 
 
Of course people who have got visible varicose veins can also have the same signs and symptoms as those with "hidden varicose veins". It is just much more obvious what the cause of these signs and symptoms is if there are visible varicose veins on the legs.
 
Therefore, in a nutshell, the signs and symptoms of varicose veins or "hidden varicose veins" are one or more of the following:
 
  • bulging veins on the legs on standing which disappear on lying down
  • aching of the legs
  • swelling of the ankles
  • thread veins of the legs
  • red or brown patches around the ankles
  • itchy skin around the lower legs or ankles
  • leg ulcers
  • painful inflammed lumps where the varicose veins used to be (phlebitis or superficial thrombophlebitis)
  • bleeding from varicose veins
 

Venous hypertension and Varicose Veins:

 
In the past, the changes listed above that are cause by venous reflux and incompetent valves in the veins, used to be called the signs of "venous hypertension". 
 
It used to be thought that the absence of valves in the vein has resulted in high pressure of blood in the veins at the ankles - hence the term "venous hypertension".
 
Now that we understand veins better, we have understood that there is no extra pressure in the veins at the ankle, and we now know that "venous hypertension" does not exist.
 
This is quite a radical statement and it needs quite a lot more explanation to understand fully. However it is quite simple when the principles of how the veins work are understood. It is fully explained in The College of Phlebology Book - "Understanding Venous Reflux - the cause of Varicose Veins and Venous Leg Ulcers".
 

Next page: How varicose veins are diagnosed

This website was last updated on 11/10/16.

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