•••Commonly, people’s thoughts about circulation are limited to the arteries. Arteries are the blood vessels that carry high pressure blood from the heart to the body. However, veins serve an equally important role. Veins return low pressure blood from our organs back to the heart. Malfunction of the veins can lead to significant medical problems.

•••In some ways, the structure of veins is more complex than the arteries. Veins differ from arteries in an important aspect, they need functioning valves for normal function. Normally, these valves only allow blood to flow in one direction, back to the heart. When the valves fail or are incompetent, a condition known as venous reflux, there is abnormal vein function. In the leg, this causes blood to pool and have trouble returning to the heart. Untreated, this leads to degeneration of the veins. Venous reflux can progress to cause itching, pain, restless legs, swelling, discoloration and even ulcer formation of the skin.

•••The degeneration of veins is described as follows: spider and reticular veins are very small dilated vessels in the skin with a blue or red appearance. Varicose veins are larger blue vessels under the skin that may feel firm or tense.

•••There are three main categories of the veins of the leg. They are classified anatomically as the deep, superficial and perforator systems. The deep veins are located inside the leg along the muscles. Clotting within them, known as deep vein thrombosis or DVT, can cause life-threatening problems such as a clot traveling to the lung, pulmonary embolism or PE. Over time, clots can destroy the function of the vein valves causing progressive symptoms of pain, swelling, skin changes and ulceration of the leg. However with proper care, the risk of this post-phlebitic syndrome can be prevented.

•••The superficial system includes what is know as the truncal veins such as the long saphenous and the short saphenous veins that travel from the groin to the inside of the ankle and from the back of the calf up to the knee. The non-truncal superficial veins are those that one can commonly see on the surface of the leg. Dysfunction of the valves of the superficial veins can lead to progressive spider, reticular and varicose veins along with symptoms of itching, pain, swelling, restless legs, skin changes and ulceration. Sometimes clotting can occur within the superficial veins that on occasion can extend into the deeper veins causing DVT. These complications may be prevented with proper treatment.

•••The perforator veins normally carry blood from the superficial system of the skin back into the deep veins. In the setting of valve dysfunction, the perforator veins allow blood from the deep system to reflux into the superficial system causing overload. This can cause the complications associated with dysfunction of both the deep and superficial veins.