What is Venous Reflux?

Venous reflux disease, also known as venous insufficiency, is a medical condition affecting the circulation of blood in the lower extremities. The tiny valves that normally force blood back up towards the heart no longer function, causing blood to pool up in the legs, and the veins of the legs become distended.

Venous reflux disease commonly produces varicose veins, the abnormally swollen and discolored superficial leg veins that affect more than 25 million Americans. Varicose veins can range from small, thin purple lines just under the skin (known as “spider veins”) to thick, bulging veins that can protrude well beyond the skin surface. In any form, varicose veins serve as indicators of venous reflux, a progressive disease that can cause significant circulatory problems as it worsens.

Common Symptoms Of Venous Reflux

In the absence of other symptoms, patients with cosmetic concerns due to the presence of varicose veins might be evaluated with only a physical examination. However, patients presenting with other symptoms of venous insufficiency, such as those listed below, should also undergo an in-depth evaluation, including a duplex ultrasound study.

  • Leg pain, aching, tired or weak legs, especially after long periods of standing or sitting
  • Varicose veins
  • Burning or itching of the skin
  • Swollen legs and/or swollen ankles (edema)
  • Color and texture changes of the skin
  • Open wounds (skin ulcers)

What is the Great Saphenous Vein?

The greater saphenous vein is a large superficial leg vein running from the foot to the groin, roughly in parallel with the short or lesser saphenous vein, which runs up the back of the leg from the ankle to the knee. These are the principal vessels of the superficial venous system in the leg.

The greater saphenous vein delivers oxygen-depleted blood from the ankle, lower leg and thigh vessels to the femoral vein, the primary deep vein in the leg. The propulsion of blood up such a significant length of the body is heavily dependent on the function of the one-way valves that prevent backflow down the vein. When those valves fail, the resultant venous reflux causes blood to back up into the smaller veins closer to the skin, distending them and initiating the condition known as varicose veins.

Venous insufficiency, also known medically as venous reflux disease, in the greater saphenous vein is a primary underlying cause of varicose veins. The great saphenous is also therefore the superficial vein most frequently treated with radiofrequency ablation to restore healthy circulation and eliminate varicose veins.

Edema & leg or ankle swelling with and without skin changes

Skin ChangesEdema and swollen ankles are the next progressive states of venous insufficiency and occur as the result of venous hypertension forcing fluid into the lymphatic and interstitial spaces.
This can cause leg or ankle swelling and changes in skin pigmentation. Severe pain and discomfort are typical of these conditions, particularly in the lower leg (calf & ankle) where proximity of nerves exacerbates the situation. In addition to superficial involvement, these stages often include some portion of the perforating or deep vein systems.

 

Active & Healed Venous Ulcers

Legs SwellingVenous ulcers indicate the most severe forms of venous insufficiency and typically involve both the deep (including perforators) and superficial vein systems. Extreme reflux and venous hypertension result in changes in the microcirculation of the skin eventually leading to severe ulceration.
Anatomic involvement at these stages generally involves the saphenous system3, the perforators (typically the Cockett perforators), and the deep system (typically the femoral, superficial femoral and/or the profunda)Why do we mention deep system and list superficial femoral? A smaller subset of the population has deep system-only involvement (<5%) and an even smaller portion perforator-only incompetence.