Stages of varicose vein disease process
C0 no visible or palpable signs of venous disease
C1 telangectasia or reticular veins
C2 varicose veins
C4a skin changes due to venous disorders: pigmentation, eczema
C4b skin changes due to venous disorders: lipodermatosclerosis, atrophie blanche
C5 same as C4, but with scars from healed ulcers
C6 skin changes with active ulcers
Causes of varicose veins
Varicose veins start to develop in the second and third decade of life, and women are affected more frequently and earlier than men. This has been linked to female hormones that are thought to decrease vein wall elasticity. Varicose veins occur due to venous reflux disease, in which vein valves do not function and blood backs up in the legs. Varicosities are related to the family history of varicose veins in at least a third of patients. Some of the known risk factors for the development of varicose veins include pregnancy, obesity, lifestyle related to prolonged standing and history of blood clots leading to chronic vein injury. In rare cases, they are related to venous malformation syndromes. Patients who are older tend to have more severe varicose vein changes, but not infrequently, young patients also encounter advanced varicose vein symptoms.
Progression of the disease
Varicose veins can manifest as a wide variety of symptoms depending on how advanced the disease process is. Initially, patients may have nonspecific complaints of pressure, like aches and heaviness in the calves that are especially present at the end of the day and are relieved with leg elevation. This can be accompanied by swelling located in the areas of the ankles and lower calves. Patients usually resolve all their symptoms after a night of rest, but the symptoms promptly return once their daily activities are resumed. At this stage of the disease, patients may have visible clusters of very small red or blue veins called spider veins, as well as slightly larger reticular veins. As the process progresses, patients develop large, bulging veins, which appear either individually or in clusters, and represent varicose veins. At later stages of the disease, increased blood pressure spreads into surrounding tissues and initiates chronic skin changes. Patients develop irreversible skin discoloration and atrophy of the fat padding that is especially seen in the inner ankle areas. Skin becomes dry, scaly, thinned and atrophic and prone to infections known as cellulitis. Whitened, irregular scar-like patches called atrophie blanch can appear at the ankles. At this point of the chronic venous disease, patients may suffer from frequent calf ulcers that start either spontaneously or after even minimal insult. These ulcers are deep, heal poorly, are long-lasting and often recur. They are frequently a source of a significant number of patients’ disabilities. The most advanced stage of varicose vein disease is referred to as stasis dermatitis, or lipodermatosclerosis.
Symptoms of varicose veins:
Swelling of the ankles.
Sensation of achy and heavy legs especially present at the end of the day.
Swelling about the ankles, along with throbbing sensations.
Calf muscle cramping; may be pronounced after leg elevation.
Pressure, pain and itching around enlarged veins.
Symptoms usually become worse after sitting or standing for a prolonged period of time.
Darkening of the skin with venous stasis dermatitis.
Complications of varicose veins:
Vein inflammation, or blood clots related in superficial veins known as superficial thrombophlebitis.
Deep-vein thrombosis, or blood clots in the deep-vein system.
Skin inflammation (stasis dermatitis).
Bleeding, either spontaneous or from light injuries, frequently seen in the elderly.