Venous Reflux Disease
Common Symptoms Of Venous Reflux
In the absence of other symptoms, patients with cosmetic concerns due to the presence of varicose veins might be evaluated with only a physical examination. However, patients presenting with other symptoms of venous insufficiency, such as those listed below, should also undergo an in-depth evaluation, including a duplex ultrasound study.
- Leg pain, aching, tired or weak legs, especially after long periods of standing or sitting
- Varicose veins
- Burning or itching of the skin
- Swollen legs and/or swollen ankles (edema)
- Color and texture changes of the skin
- Open wounds (skin ulcers)
Varicose Veins
Varicose veins are typically found in the superficial venous system and often involve the main trunk veins - the great and small saphenous veins - as well as tributaries.
Varicose veins are superficial veins that have expanded in response to increased pressure caused by incompetent or absent valves. Progressive vein dilation eventually prevents the valve cusps from closing properly resulting in reflux. Alternatively, a lack of competent valves can also cause dilation of the vein. As one valve fails, increasing pressure is exerted on each more distal valve until it, too, becomes incompetent. Diameters of varicose veins can range from 3 mm to > 8 mm.2
Edema & leg or ankle swelling with and without skin changes
Edema and swollen ankles are the next progressive states of venous insufficiency and occur as the result of venous hypertension forcing fluid into the lymphatic and interstitial spaces.
This can cause leg or ankle swelling and changes in skin pigmentation. Severe pain and discomfort are typical of these conditions, particularly in the lower leg (calf & ankle) where proximity of nerves exacerbates the situation. In addition to superficial involvement, these stages often include some portion of the perforating or deep vein systems.
Active & Healed Venous Ulcers
Venous ulcers indicate the most severe forms of venous insufficiency and typically involve both the deep (including perforators) and superficial vein systems. Extreme reflux and venous hypertension result in changes in the microcirculation of the skin eventually leading to severe ulceration.
Anatomic involvement at these stages generally involves the saphenous system3, the perforators (typically the Cockett perforators), and the deep system (typically the femoral, superficial femoral and/or the profunda)Why do we mention deep system and list superficial femoral? A smaller subset of the population has deep system-only involvement (<5%) and an even smaller portion perforator-only incompetence.
1 Barron HC, Ross BA. Varicose Veins: A guide to prevention and treatment. NY, NY: Facts on File, Inc. (An Infobase Holdings Company); 1995;vii.
2 Goldman M. Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins. 2nd ed. Mosby; 1995. p. 250-251, 431-465.
3 Labropoulos N. The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency, J Vasc Surg 1996; 23:3:504-510.
Text Size:
