the walls and failure of the valves to function.
Varicose veins can result in superficial phlebitis.
That is the veins are sitting on the surface,
they can be easily traumatized with a small
bruise or traumatic injury. This leads to
inflammation and can lead to thrombosis.
But superficial phlebitis in a varicose vein
usually doesn’t result in pulmonary embolism.
Treatment is local heat, for example with
a heating pad; elevation of the extremities
so you help the vein to drain; and then drugs:
aspirin or ibuprofen can reduce the inflammation
and reduce the tendency towards clot forming.
The combination of varicose veins and deep
inside venous insufficiency – that is the
valves not working well or internal varicose
veins if you will – that increases the risk
for DVT – deep venous thrombosis – and
pulmonary embolism because the blood tends
to stagnate there. And also the walls of these
veins are not normal in terms of their ability
to prevent blood clots from forming. And so
the deep system can become thrombosed and
that can lead to pulmonary embolism. And we’ve
talked about how dangerous pulmonary embolism
With the patients who have this situation
chronically – that is they have deep vein
insufficiency, the veins are dilated internally,
the valves don’t work well – it is very
common that there is congestion of the tissue
with the blood that doesn’t drain adequately
out of the legs. Edema – or swelling – occurs.
Lots of fluid in the tissues. Again, as I
mentioned before, as the swelling goes up
in the tissues, tissue nutrition – getting
blood, oxygen and nutrients to the cells – becomes
impaired. And you can actually have necrosis,
or death, of tissue, particularly the subcutaneous
– that is the fat deposits under the skin.
These skin areas develop brown pigmentation.
What happens here is that red blood cells
escape from the capillaries because of the
high pressure. They degenerate there and they
deposit hemoglobin which is metabolized locally
into a compound called hemosiderin which is
an iron compound derived from hemoglobin
and is brown. And so the skin, as you can
see in the picture there, is quite brown in
the lower extremity from chronic venous disease.
Again, so much fluid develops that the lymphatics
are unable to drain it. And you may actually,
because of inadequate nutrition, get scarring
or sclerosis of the lymph channels and this
even further increases the amount of swelling
in interstitial fluid. And you may even get
a form of dermatitis – or skin inflammation
– and venous ulcers, as I’ve already talked
about. And in very severe cases it might even
lead to amputation.