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Venous insufficiency should be treated before the varicose veins




In order to maintain the leg circulation, the arteries should be able to bring oxygenated blood to the tissues, and the veins should be able to collect the deoxygenated blood from the leg and send it to the lung. For the venous blood in the leg to go to the lung, it must flow upwards in the opposite direction to gravity. Our body has developed two mechanisms to achieve this.


1. Pumping of the leg muscles: Contraction of the leg muscles during movements such as walking, running, squeeze the veins and pump the venous blood up.

2. Unidirectional operation of venous valves: These valves allow unidirectional flow, such as "check valve"; when the muscles contract these valves open and let the blood go up. When the muscles relax, they close and prevent the blood from flowing back.


Thanks to these two mechanisms, our legs can continually send venous blood to the lungs and ensure our leg circulation is healthy. When one of these mechanisms breaks down, the deoxygenated blood begins to accumulate in the legs. Disturbance of the muscle pump is rare and occurs in diseases that weaken the leg nerves or muscles. Vascular valve deterioration is a much more common condition and is defined by terms such as venous insufficiency, venous incompetence, valve insufficiency, reflux or leakage.


In venous insufficiency, the leg muscles send the venous blood up, but the valves cannot stop it and, under the influence of gravity, the venous blood begin to flow back through the incompetent vessel to the foot. This venous blood accumulates in the legs and can cause pain, burning, itching, swelling and cramping. These complaints can also be seen before the appearance of varices.


When venous insufficiency first starts, our body notices that this vessel is not working well and directs the venous blood accumulated in the leg to the main healthy veins (deep veins) via the small connecting vessels (perforating veins). That is, the function of the diseased vessel is transferred to the healthy vessels from the beginning of venous insufficiency. Therefore, laser ablation or surgical removal of the diseased vessel is not a problem in the treatment of venous insufficiency, since healthy vessels have already taken over the function of the incompetent vein.


Years after the onset of venous insufficiency, the first varices appear. These varices grow and become more protruding. Varicose veins are caused by increased blood pressure due to venous insufficiency. Once venous insufficiency begins, it does not resolve spontaneously or with medication. The deformation of the valves increases and the vessels and varices expand by time. In other words, after venous insufficiency begins, it cannot be regressed; However, the rate of progress may vary from person to person.


Venous insufficiency is mostly seen in superficial veins and its treatment is based on the elimination of the diseased vessel. As mentioned above, cancellation of this vein does not cause anything to lose to the leg, because other healthy vessels have already taken over its function. Deep vein insufficiency is more rare and usually occurs after thrombosis of deep veins (post thrombotic syndrome). In the case of deep vein insufficiency however, the damaged vessel can not be removed or laser-ablated. Because the deep veins are the main veins (highway) of our legs. If these veins are completely closed, superficial vessels, no matter how well they function, cannot compensate for deep veins. Therefore, surgical or interventional treatments are not applied in deep venous insufficiency

 Video: Why is Doppler ultrasound so important in varicose veins? 

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