Venous diseases are widespread among the general population. According to a study by the German Society of Phlebology, one in every two women suffers from mild venous disorders. One in every five women and one in every six men has an advanced venous disorder requiring treatment (Source: Bonn Vein Study).
Veins transport oxygen-poor blood back to the heart. Along the way, the blood passes through the liver, which filters out harmful substances. The blood is then pumped by the heart to the lungs. There, it is saturated with fresh oxygen and subsequently returns to the heart via the pulmonary artery. From there, it is pumped back into the systemic circulation.
Arteries, therefore, carry oxygen-rich blood to the organs and tissues. Veins, on the other hand, carry the blood back afterward. The cycle begins anew.
From areas of the body located below the heart, blood can only flow upward against gravity. This is why problems with the leg veins are common.
The arteries are shown in red, the veins in blue © pixdesign123 / Fotolia
Where do the veins run?
Some veins run deep within the muscles, which is why medical professionals refer to the deep venous system. However, there are also what are known as superficial veins, which lie just beneath the skin. The superficial veins of the arms and, in particular, the legs are prone to dilation because they must constantly work against gravity.
The venous system is divided into four regions of the body:
- Head and neck veins, including the internal and external jugular veins (V. jugularis interna and externa)
- Arm veins, including the ulnar veins (Vv. ulnares), radial veins (Vv. radiales), brachial vein (V. brachialis), axillary vein (V. axillaris), and subclavian vein (V. subclavia). Together with the head and neck veins, the arm veins drain into the superior vena cava (Vena cava superior)
- Abdominal veins, including the portal vein (V. portae) and the inferior vena cava (V. cava inferior), which leads into the right atrium.
- Leg veins, comprising the deep (femoral, popliteal, and crural veins) and superficial (great and small saphenous veins) leg venous systems, connected by the perforating veins.
What is unique about the venous system?
The walls of veins and arteries are composed of three layers. Compared to arteries, which have higher pressure, veins, however, have thinner walls and are less elastic. These characteristics make them susceptible to venous insufficiency.
In addition, blood in the veins must be transported upward against gravity toward the heart. Since pressure is lower in the venous system, the body has several mechanisms for transporting blood upward. The most important mechanisms are the joint and muscle pumps, which compress the vein from the outside and push the blood upward. Venous valves ensure that blood does not flow backward. These valves allow blood to flow in only one direction; they open during upward transport and close if the blood were to flow backward.
Veins and arteries function like a piping system © Giovanni Cancemi / Fotolia
How exactly do the joint and muscle pumps work?
Blood is transported back against gravity. The rising and falling of the chest during breathing creates a slight negative pressure in the ventricle. This draws blood from the veins. However, this effect is not strong enough to ensure blood circulation all the way to the peripheral vessels. That is why muscle contractions take over this task.
The contraction of the muscles—known as the muscle pump—exerts pressure on the veins and forces blood out of the blood vessels. A similar effect is created by the movement of the ankle joint in the foot.
A kind of valve system prevents backflow when the pressure subsides. Venous valves stop venous backflow into the lower parts of the body. They open to allow blood pushing up from below and close when blood pushes down from above.
Healthy vein and venous valves (left) and diseased vein with varicose veins (right) © Solarisys | AdobeStock
Both superficial veins—those located directly under the skin—and deep veins—those located between the muscles—can become diseased.
In the case of superficial veins, the disorders usually involve the venous valves; in deep veins, they involve the formation of clots, a condition also known as thrombosis.
Disorders of the superficial venous system:
Diseases of the deep leg veins:
Typical symptoms of venous diseases of the legs include:
- Swelling (edema)
- Skin changes (brownish discoloration)
- Open leg (large wounds, usually on the lower leg)
Visible varicose veins, spider veins, and pain along the course of the vein are also typical signs. In the case of thrombosis, patients often notice sudden swelling in a leg accompanied by pain and a feeling of tightness. This is usually preceded by a long car or plane trip or surgery requiring bed rest.
Regular exercise is essential for vein health:
- On long-haul flights, wiggle your toes up and down to engage your calf muscles.
- Stretch your legs during rest stops on long car trips.
- Use your breaks at the office to take a short walk.
- All endurance sports, such as walking or cycling, help the muscle pump transport venous blood.
- For people diagnosed with venous insufficiency or a family history of varicose veins, vein exercises and compression stockings are recommended.
Exercise is good for your veins © Nastassia Yakushevic / Fotolia
In general, standing and sitting should be avoided; walking and lying down are good for the veins. A lack of regular exercise over a long period of time leads to varicose veins. The venous valves close only partially, and blood pools. The affected section of the vein dilates, and the vessel may become visible as a winding line beneath the skin.
The blood pooled in the vein releases fluid into the surrounding tissue, causing the limbs to swell. Due to the loss of fluid, the venous blood thickens, which can lead to the formation of blood clots (thrombosis).
Compression stockings compress the veins, allowing the venous valves to close properly again © antaya / Fotolia
Are there any typical warning signs that indicate a venous disorder?
Spider veins and varicose veins on the legs are typical symptoms of venous disease and are very common in the general population.
In rare cases, the venous valves are not formed properly. This may be due to a genetic defect.
Fluid retention and “heavy legs” are early signs of a problem in the venous system. They can be alleviated through exercise and by elevating the feet.
Unhealthy habits such as smoking lead to deposits in the veins and unnecessarily disrupt blood flow.
- Alcohol consumption,
- being overweight, and
- wearing high-heeled shoes
also damage the veins. However, venous diseases can also occur in old age or during pregnancy.
Many people ignore the early symptoms of venous disease. Yet these symptoms are warning signs of a steadily deteriorating venous function. The sooner those affected take action, the better their chances of success.
Tell your doctor if you notice any symptoms in your legs.
To diagnose a venous condition, the doctor will first conduct a medical history interview with you. During this, they will ask about your specific symptoms and medical history. A family history of vascular diseases is also important.
The doctor will then examine the affected areas of the body, paying particular attention to visible spider veins, bulging superficial veins, and swelling in the lower legs and feet.
Examination of spider veins © doroguzenda / Fotolia
Using light-reflection rheography (LRR measurement), the doctor performs a vein check while the patient is seated. The patient wiggles their foot to activate the muscle pump. During this process, sensors placed above the ankle measure the time it takes for the vein to refill with blood.
To examine the affected area in greater detail, the Doppler method (duplex sonography) is used. The venous Doppler uses ultrasound to visually and audibly map the activity within the veins.
The doctor can identify any blood clots, assess the thickness of the vein wall, and evaluate the condition of the venous valves. High-quality devices also display the direction of blood flow in color.
As a general rule, venous diseases are harmless, especially since they usually affect the superficial veins. However, in extreme cases, deep vein thrombosis can lead to a pulmonary embolism if clots are carried through the bloodstream to the lungs. This may require intensive care treatment. In addition, severe leg swelling may result, which ultimately restricts the supply of oxygen-rich blood and can then put the leg at risk. This is, however, extremely rare; in the vast majority of cases, the swelling can be managed very effectively with compression therapy and by elevating the leg.
How do venous disorders develop?
Venous diseases develop when the return flow of blood from the legs to the heart is impaired and blood flow is abnormally slowed. Common causes include a congenital weakness of the connective tissue, hormonal influences (e.g., pregnancy, hormone replacement therapy), and a lack of physical activity. In particular, standing or sitting for long periods, as well as prolonged sitting or standing, can impair the return of blood to the heart. This leads to the development of typical conditions such as venous insufficiency, varicose veins, or post-thrombotic syndrome.
How can I recognize venous insufficiency?
Early signs of venous insufficiency include heavy legs, tired legs, swelling, and pain—especially in the evening. Many people affected notice reddish or bluish discoloration of the skin, fine spider veins, or the first signs of varicose veins. As the condition progresses, skin changes, itching, and a slow-healing lower-leg ulcer may occur—this is a clear sign that venous insufficiency is already advanced and should be evaluated by a doctor.
Why aren’t venous disorders harmless?
At first, varicose veins or other venous complaints often seem to be merely a cosmetic concern, but in reality, they are usually caused by a pathological dysfunction of the venous valves. If the condition remains untreated, it can lead to inflammation, venous weakness with chronic insufficiency, and, in the worst case, venous thrombosis. If a blood clot breaks loose, there is a risk of pulmonary embolism—which is why pronounced venous conditions should always be taken seriously and evaluated by a specialist.
What can I do on my own to prevent venous diseases or alleviate symptoms?
Regular exercise, weight loss, and avoiding prolonged standing or sitting help improve venous return and alleviate symptoms. In everyday life, it’s better to walk and lie down than to just sit or stand; elevate your legs from time to time and do calf exercises. Drinking plenty of fluids, wearing loose-fitting clothing, and wearing flat shoes also support vein health and can slow the progression of venous insufficiency.
What role do compression stockings play in the treatment of venous disorders?
The treatment of venous disorders often relies on wearing compression stockings. Medical compression stockings apply external pressure to the vein walls, improve blood return, and can significantly reduce swelling and pain. A well-fitted stocking stabilizes dilated veins, prevents blood pooling, and helps slow the progression of the disease. They are a central element of the treatment of venous diseases and are specifically selected and prescribed by a specialist based on the severity of the condition.
