Hello! We’re continuing with Advanced Vascular
Medicine. And we are continuing to speak about
In this segment, we’re going to talk about
varicose veins and venous insufficiency. In
other words, inadequacy of the veins to do
their job normally.
So what are varicose veins?
Varicose veins are externally visible veins.
They’re dilated and tortuous and they’re
seen in the lower extremity. And they’re
often the result of gravity which, of course,
as you know increases the pressure inside
the vein and, and particularly with a certain
genetic kind of predisposition, the veins
dilate and become easily visible on the surface.
And as you can see here in the figure, the
varicose veins are clearly seen on the left-hand
figure where they are evident on the surface
whereas in the normal, healthy leg on the
other side, the veins are not visible.
There are various forms or various causes,
or subdivisions if you will, of varicose veins.
There are primary varicose veins. They originate
from the superficial saphenous vein in the
leg and they usually don’t cause much trouble.
The ones that cause more trouble are the secondary
ones that result in impaired flow in the deep
venous channel. And this increases the risk
for deep venous thrombosis. It occurs commonly
in patients who’ve had earlier deep venous
thrombosis. So now they can have recurrent
venous thrombosis. In some people it’s congenital.
There are genetic predispositions to this.
Pregnancy of course markedly increases the
pressure in the lower extremities because
the pregnant uterus is sitting on the inferior
vena cava and the iliac veins and therefore
increasing pressure below the pelvis in the
leg. And of course, if these varicose veins
connect up in a system where there’s internal
varicose veins, then the valves don’t work,
blood tends to pool in these veins and edema
– or swelling – results. And again, as
we’ve talked about in the last lecture,
the swelling can even become so severe that
it impairs tissue nutrition and you have death
of tissue – necrosis – and ulceration.
Varicose veins are very common entities. Interestingly
enough by the way, they’re related to hemorrhoids.
Hemorrhoids are varicose veins of the anus.
But what we’re speaking about here are varicose
veins in the leg.
So let’s talk a little bit about what are
the mechanisms that lead to varicose veins.