Venous diseases are widespread in the population. According to a study by the German Society for Phlebology, every 2nd woman suffers from minor venous disorders. Every 5th woman and every 6th man has advanced venous disease that requires treatment (source: Bonn Vein Study).
Veins transport deoxygenated blood back to the heart. It passes through the liver, which filters out harmful substances. The blood is then pumped through the heart to the lungs. Here it is saturated with fresh oxygen and then returns to the heart through the pulmonary artery. From here it is pumped back into the large circulatory system.
Arteries therefore transport oxygen-rich blood to the organs and tissues. Veins, on the other hand, return the blood. The circulation begins again.
Blood can only rise against gravity from areas of the body that lie below the heart. This is why the leg veins often cause problems.
The arteries are shown in red, the veins in blue © pixdesign123 / Fotolia
Where do the veins run?
Some veins run deep into the muscles, which is why medicine refers to them as the deep venous system. However, there are also so-called superficial veins, which lie just under the skin. The superficial veins of the arms and especially the legs are prone to dilatation as they have to constantly work against gravity.
The venous system is divided into four body regions:
- Head and neck veins with internal and external jugular veins (V. jugularis internaexterna)
- Arm veins with ulnar veins (Vv. ulnares), radial veins (Vv. radiales), large brachial vein (V. brachialis), axillary vein (V. axillaris), subclavian vein (V. subclavia). Together with the head and neck veins, the arm veins flow into the superior vena cava
- Abdominal veins with portal vein (V. portae) and inferior vena cava (V. cava inferior), which leads into the right atrium.
- Leg veins with the deep (V. femoralis, poplitea and Vv. crurales) and superficial (V. saphena magna and parva) leg vein system and the perforating veins as a connection.
What is special about the venous system?
The vascular walls of the veins and arteries have a three-layer structure. However, compared to arteries, in which there is higher pressure, veins have thinner walls and are less elastic. These properties make them susceptible to venous insufficiency.
In addition, the blood in the veins has to be transported upwards towards the heart against the force of gravity. As there is lower pressure in the venous system, the body has several mechanisms to transport the blood upwards. The most important mechanisms are the joint and muscle pump, which compresses the vein from the outside and pushes the blood upwards. Venous valves ensure that the blood does not flow backwards. These only allow the blood to flow in one direction, so they open when the blood is transported upwards and close when the blood would flow back.
Veins and arteries work like a pipe system © Giovanni Cancemi / Fotolia
How exactly do the joint and muscle pump work?
Blood is transported back against the force of gravity. Raising and lowering the rib cage when breathing creates a minimal negative pressure in the ventricle. This sucks the blood out of the veins. However, the effect is not strong enough to ensure blood exchange to the peripheral vessels. Muscle contractions therefore take over this task.
The contraction of the muscles, known as the muscle pump , exerts pressure on the veins and pushes the blood out of the blood vessels. A similar effect is created by the movement of the ankle joint in the foot.
A kind of sluice system prevents the return flow when the pressure decreases. Venous valves stop the venous return flow to the lower parts of the body. They open to the blood pushing up from below and close when the blood pushes down from above.
Healthy vein and venous valves (left) and diseased vein with varicose veins (right) © Solarisys | AdobeStock
Both the superficial veins, i.e. those located directly under the skin, and the deep veins, which are located between the muscles, can become diseased.
In the case of superficial veins, it is usually a matter of diseases of the venous valves, while in the case of deep veins it is the formation of clots, which is also known as thrombosis.
Diseases of the superficial venous system:
Diseases of the deep leg veins:
Typical symptoms of venous diseases of the legs are
- Formation of swelling(oedema)
- Skin changes (brownish discoloration)
- Open leg (large wounds, usually on the lower leg)
Visible varicose veins, spider veins and pain over the course of the vein are also typical signs. In the case of thrombosis, patients often notice a sudden swelling of the leg with pain and a feeling of tightness. It is usually preceded by a long journey by car or plane or an operation requiring bed rest.
Regular exercise is essential for the veins:
- On long-haul flights, move your toes up and down to tighten the calf muscles.
- Stretch your legs during a break on long car journeys.
- Use the break in the office for a short walk.
- All endurance sports such as walking or cycling support the muscle pump in the removal of venous blood.
- Vein exercises and compression stockings are advisable for people with diagnosed venous insufficiency or a family history of varicose veins.
Exercise is good for the veins © Nastassia Yakushevic / Fotolia
In principle, standingand sittingshould be avoided; walkingand lying downare good for the veins. If there is a lack of regular exercise over a long period of time, the veins become distended. The venous valves only close partially and the blood builds up. The affected section of the vein widens and the vessel can be seen to be tortuous under the skin.
The congested blood in the vein releases water into the surrounding tissue and the limbs swell. The loss of fluid causes the venous blood to thicken and can lead to vascular occlusion(thrombosis).
Compression stockings compress the veins so that the venous valves can close properly again © antaya / Fotolia
Are there typical warning signs that indicate a vein disease?
Spider veins and varicose veins on the legs are typical symptoms of diseased veins and are widespread among the population.
In rare cases, the venous valves are not positioned correctly. This may be due to a genetic defect.
Water formation and "heavy legs" are the first signs of a disorder in the venous system. They can be alleviated by exercise and elevating the feet.
Unhealthy behavior such as smoking leads to deposits in the veins and disrupts the blood flow unnecessarily.
- Alcohol consumption,
- obesity and
- wearing high-heeled shoes
also damage the veins. However, vein diseases can also occur in old age or during pregnancy.
Many people ignore the first symptoms of venous disease. Nevertheless, they are the harbingers of a continuous deterioration in vein function. The earlier those affected start taking measures, the better the chances of success.
Inform your doctor if you notice any symptoms in your legs.
To diagnose a vein problem, the doctor will first discuss your medical history with you. He or she will ask you about your exact symptoms and medical history. Family history of vascular diseases is also important.
He then examines the affected areas of the body and pays particular attention to visible spider veins, bulging of the superficial veins and swelling in the lower leg and foot area.
Examination of spider veins © doroguzenda / Fotolia
With light reflection rheography (LRR measurement), the doctor performs a vein check while the patient is seated. The patient rocks their foot to activate the muscle pump. Probes above the ankle measure the time it takes for the vein to refill with blood.
The Doppler procedure (duplex sonography) is used to look deeper into the affected area. The venous Doppler uses ultrasound to create a visual and acoustic image of what is happening in the veins.
The doctor can detect any thromboses, the thickness of the vein wall and the condition of the venous valves. High-quality devices also display the direction of blood flow in color.
As a rule, venous diseases are harmless, especially as the superficial veins are usually affected. In extreme cases, however , thrombosis of the deep veins can lead to a pulmonary embolism if clots are transported via the bloodstream to the lungs. This may require intensive medical treatment. In addition, massive leg swelling can result, which ultimately also restricts the supply of oxygen-rich blood and then also endangers the leg. However, this is extremely rare; in the vast majority of cases, the swelling can be controlled very well with compression therapy and elevation of the leg.
