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What are Veins and Varicose Veins?

What are Veins?

Veins are the blood vessels that return blood to the heart after the oxygen and nutrients have been removed.

There are two main systems of veins in our legs. The deep veins that drain most of the blood and superficial veins which are close to the skin. There are two main veins in the superficial system: The long saphenous vein which runs from our ankles to our groins on the inner side of our legs and the short saphenous system which runs from the ankle to the back of the knee on the outside of our legs.

If one thinks of the deep veins as the main motorways for blood to flow in, then the long and short saphenous veins are the A roads while the smaller superficial veins are the B roads and country lanes.

When we stand up, you can imagine that all the blood in veins would run down to our feet because of gravity. This does not happen because the veins in our legs have special non-return valves that allow blood to go towards the heart but not back to our feet. The veins are therefore one-way roads.

What are Varicose veins?

Varicose veins occur when the superficial veins near the skin become diseased so that they get bigger (dilate) and the valves break (incompetent). This means the veins become two-way roads so that they fill up instead when someone stands (reflux). If someone has varicose veins, when they stand up the veins become more visible or lumpy like bunches of grapes. The veins no longer work properly.

Are varicose veins common?

Varicose veins often run in families and nearly 4 in every 10 people in the country have varicose veins of some kind.

What problems do varicose veins cause?

For most people the only problem is that the veins do not look nice so some people do not wear shorts or skirts.

For some their legs ache after standing for long times. This can happen to people without varicose veins. In those with varicose veins, the refluxing blood fills veins in the calves. This blood stretches the muscles in the legs and makes them ache.

Some people find that their ankles swell at the end of the day. When they wake after lying in bed the swelling has gone. Swelling can be uncomfortable and is caused by fluid leaking out of the veins.

When varicose veins are more severe, the skin around the ankle can turn brown and can flake and itch. This condition is know as venous eczema or lipodermatosclerosis. If this occurs then there is a risk that an ulcer (sore) can develop around the ankle.

What should I do if I have varicose veins?

If you are concerned about your legs then you should first discuss the problem with your GP( family practitioner). They may refer you to a hospital doctor for a further opinion. Although any General Surgeon should be able to give sound advice, many would recommend that you should see a specialist vascular surgeon.

Why do varicose veins come back (recurrent varicose veins)?

There are several reasons for recurrent varicose veins:

1.    Inadequate surgery. In the past some surgeons were not confident about operating near the deep veins of the leg or though they did not have to. In these cases, the varicose veins may have never been improved after the first operation. Now that most vein operations are done by specialist vascular surgeons, this cause of recurrence is likely to become uncommon.

2.    Neovascularisation. The body tries to repair what a surgeon does at the time of varicose vein surgery. New veins grow where the surgeon has tied off the junction between the deep and superficial veins. These new veins grow by a process called neovascularisation. With time they connect to other more major veins and cuase recurrence of the varicose veins. This is more likely if the long saphenous vein (A road) is not removed at the time of the primary surgery. It is for this reason that Mr Braithwaite nearly always removes the long saphenous vein.

3.    Normal veins become varicose. If you have varicose veins then you have a tendency to have a structural weakness in the vein wall. With increasing age, other veins can become weak. This often occurs several years after varicose vein surgery.

What happens if my GP does not refer me to a specialist?

You may be happy with the advice you GP has given you. If not consider asking to see another GP if you wish to be treated as an NHS patient. In some areas of the United Kingdom, Health Authorities have set guidelines for the referral of patients with varicose veins. It is currently illegal to ration healthcare so you may have to insist on being referred although your GP will probably be supported by the specialist in saying that your legs do not need treatment.

An alternative is to seek an appointment with a specialist vascular surgeon as a private patient. Some consultants will see you without a letter from your GP but they will nearly always write to your GP to tell them you have been seen. You can ask for a private consultation by ringing your local private hospital.