Understanding Our Anatomy

Circulation is the process by which blood flows away from the heart to the rest of the body and then back to the heart again. We have two types of blood vessels: Arteries that carry oxygenated blood away from the heart and veins which return blood to the heart. Veins and arteries vary greatly. Arteries are under more pressure. (Blood pressure of 120 mmHg is normal arterial pressure. The blood pressure of a vein in the same location might vary from 6-15 mmHg.) Because veins have such little assistance from the heart, they compensate by having one-way valves that help the blood constantly move in one direction. The veins also rely a great deal on the movement of our leg muscle squeezing the veins and thus pushing the blood along. (That's why leg swelling is often worse at the end of the day after sitting or standing for an extended time. The leg muscles when we walk actually pump the blood in the veins back to the heart.) There are two vein systems in our legs: the "deep" system that lies in our calf and thigh muscles and is responsible for 90% of blood return from our legs back to our heart and the "superficial" system that lies in the space between our muscles and our skin. The superficial system is made up primarily of the Greater and Lesser Saphenous veins. These are the same veins that are "harvested" and used for bypass grafts in open-heart surgery and peripheral arterial disease. If these veins are damaged or do not function well, they are not a good choice to use for these operations so alternative grafts (arterial, synthetic or cadaver) are considered for use in their place. As we mentioned, all veins have one-way check valves which prevent reverse blood flow. When they do fail, blood flows backwards into the veins and causes them to be under more pressure and eventually enlarge. When these valves fail, this is called venous reflux and is the principal cause of varicose veins and multiple symptoms.

Signs and Symptoms of Venous Reflux Disease

Venous reflux disease is much more than just the appearance of bulging, sometimes painful varicose veins. In fact, many people have no visible signs but instead have complaints of leg pain, achiness, end-of-day leg fatigue, night cramps, leg or ankle swelling and itching. Most patients present with one or a combination of the symptoms with or without the presence of varicose veins. The underlying condition, venous reflux disease or venous insufficiency (or in lay terms "varicose vein disease"), is a medical condition that affects up to 50% of the adult population. Women are affected one and a half times more frequently than men. Once you have varicose veins, they often worsen as you become older. If either of your parents have varicose veins, you are more likely to have them yourself.

Diagnosis and Treatment

Diagnosis is based on a combination of symptoms, a physical exam and, most importantly, an ultrasound (sound wave) test of the deep and superficial veins in your legs. This is a noninvasive test that can quickly and easily be performed in the office. If you are diagnosed with venous reflux disease, treatment begins with conservative measures such as daily walking, elevating your feet, taking over-the-counter medications like ibuprofen or Tylenol for pain and, most importantly, wearing compression hose prescribed by your healthcare provider. If you don't have significant relief of symptoms, then outpatient surgery performed in a doctor's office is often recommended.

Where to Begin

In our office, we offer an initial free screening where we evaluate your symptoms to help us decide what, if any, tests may be required to confirm a diagnosis. To schedule your screening or for more information, contact us: Great Lakes Cardiothoracic and Vascular Surgery, 2390 Mitchell Park Dr., Suite B., Petoskey, MI 49770, (231) 487-9090 or (800) NMICHMD, or go to our website: www.glcvs.com.