Varicose veins are veins that have become distended and tortuous. The most common sites are the veins of the legs, however it is possible to find varicose veins in the testes and the esophagus.
There is an inherited factor in some incidences, and certain conditions such as pregnancy or obesity can aggravate the problem. The varicose veins that you see are the superficial veins of the legs, which have become engorged by blood and distended because of inefficiency involving the deeper veins.
Varicose veins in the legs only arise from the fact that the venous blood supply in the lower limbs has to return to the heart against gravity.
It is a problem that is partly overcome by a series of valves within the veins of the leg. Blood is pushed upwards inside the veins by the action of the leg and buttock muscles contracting and squeezing as in walking.
Blood flows pass the valves during the contraction by the muscles, then as the contraction stops, as the muscle relaxes, they can close and retain the blood above them, until the next muscle contraction squeezes and forces the next column of blood up the vein. If the valves are incompetent they will leak and not all the blood will remain above this valve slowing down the steady flow. If the blood cannot flow swiftly up the leg it remains longer in the limb and the blood will try and disperse to other veins and in the tissues themselves. This leads to the superficial veins becoming overloaded. Inefficiency in the valve is one of the main causes of this problem and inherited factors involving valve shape and blood vessel elasticity is also part of the problem.
Any anatomical anomaly that can cause an obstruction for the blood flow also increases the risk of varicosities. The pathway of the veins in the legs differs slightly from left to right.
On the right side the vein from the leg flows upwards to meet the renal vein at an angle, a bit like gliding on to the motorway from a slip road, the flow is continuous.
On the left side the junction between the leg vein and the renal is more like a 'T' junction so the flow slows down as there is a counter flow going across its pathway. This acts as a very minor obstruction and in most people it causes no problems at all, but in some who have other weaknesses in their system, this can be an added drawback and you will often see more unilateral varicose vein problems in the left leg or left testes.
Standing still for too long can aggravate the problem as the veins rely on rhythmic contraction to work well. Once the veins have become varicose, the legs can start to ache.
As the circulation is generally compromised you can get leg ulcers which can be difficult to heal and blood clots in the veins causing phlebitis, a hard, red painful area. It is also possible to get a form of varicose eczema related to the poor circulation.
Treatment in mild cases is to try support hose, which can re-enforce the action of the leg muscles. In many cases this is often only a temporary measure surgically stripping the veins or tying them to force the blood flow back in the direction of the deeper veins is more beneficial in the long term.
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