Varicose veins are permanent swelling of the superficial veins, typically in the legs, which are produced due to the dysfunction in the return action of the blood from the extremities to the heart.
The function of the arteries is to transport blood from the heart to the rest of the tissues, and that of the veins is to return the blood from the rest of the body to the heart so that it returns to circulate. Varicose veins originate due to a weakness in venous valves and walls, and some structures located in the veins that help the flow of blood to always be in the ascending direction (from the legs to the heart). If these fail, it appears what is called reflux, this means that the blood, instead of going upwards to the heart, accumulates within the veins of the legs.
Classification of varicose veins
According to their size:
Telangiectasia or spider veins. They are very small, swollen veins situated within the skin itself. They are so small that, normally, they cannot be seen by just looking, although when they swell, their outline can be seen through the skin in the form of blue coloured tracks. The large majority are usually exclusively an aesthetic problem.
Reticular varicose veins. They are enlarged, visible, subcutaneous veins of a few millimetres. On being larger than spider veins, they are palpable when they are swollen. They can be associated with occasional discomfort in the form of itching or tired legs.
Trunk varicose veins. They are swelling of the main trunks of the superficial venous system or of its branches. They are clearly palpable and usually cause discomfort (itching, pain, swelling, tired legs…). In some circumstances, they can lead to complications in the form of phlebitis, bleeding, or skin changes, such as darkening or atrophy of the skin and, finally, ulceration.
Depending on their cause:
Congenital. They appear from birth.
Primary or essential. They appear after birth, although of unknown cause.
Secondary. They appear after birth, but due to a cause, usually trauma or thrombosis of the deep venous system.
According to their location or anatomy. Associated with the internal saphenous vein, anterior saphenous vein, external saphenous vein, perforator veins of the leg…
Depending on the causal mechanism. Owing to the dysfunction of the venous system due to reflux or obstruction.
There is a classification called CEAP (Clinical, Etiology, Anatomy, Pathophysiology) that groups all those previously described, enabling each case of varicose veins to be individually classified and standardised.
How many people are affected by Varicose veins?
It is estimated that 25% of the adult population in the Western world (1 in every 4 people) have frank (trunk) varicose veins, although if spider veins and reticular varicose veins are taken into account, the percentage increases up to around 70%.
They are more common in women, as well as people of advanced age. Other circumstances can increase their prevalence, such as overweight, lifestyle, or profession, among others.