NOMER SATU

Veins return blood to the heart from all the organs of the body. The large veins parallel the large
arteries and often share the same name, but the pathways of the venous system are more difficult
to trace than those of the arteries. Many unnamed small veins form irregular networks and
connect with the large veins.

Many veins, particularly those in the arms and legs, have one-way valves. Each valve consists of
two flaps (cusps or leaflets) with edges that meet. Blood, as it moves toward the heart, pushes the
cusps open like a pair of one-way swinging doors. If gravity or muscle contractions try to pull
the blood backward or if blood begins to back up in a vein, the cusps are pushed closed,
preventing backward flow. Thus, valves help the return of blood to the heartby opening when
the blood flows toward the heart and closing when blood might flow backward because of
gravity.

The body has

Superficial veins, located in the fatty layer under the skin

Deep veins, located in the muscles and along the bones

Short veins, called connecting veins, link the superficial and deep veins.

The deep veins play a significant role in propelling blood toward the heart. The one-way valves
in deep veins prevent blood from flowing backward, and the muscles surrounding the deep veins
compress them, helping force the blood toward the heart, just as squeezing a toothpaste tube
ejects toothpaste. The powerful calf muscles are particularly important, forcefully compressing
the deep veins in the legs with every step. The deep veins carry 90% or more of the blood from
the legs toward the heart.

Deep Veins of the Legs

One-Way Valves in the Veins
One-way valves consist of two flaps (cusps or leaflets) with edges that meet. These valves help
veins return blood to the heart. As blood moves toward the heart, it pushes the cusps open like a
pair of one-way swinging doors (shown on the left). If gravity momentarily pulls the blood
backward or if blood begins to back up in a vein, the cusps are immediately pushed closed,
preventing backward flow (shown on the right).

Superficial veins have the same type of valves as deep veins, but they are not surrounded by
muscle. Thus, blood in the superficial veins is not forced toward the heart by the squeezing
action of muscles, and it flows more slowly than blood in the deep veins. Much of the blood that
flows through the superficial veins is diverted into the deep veins through the many connecting
veins between the deep and superficial veins. Valves in the connecting veins allow blood to flow
from the superficial veins into the deep veins but not vice versa.

Problems With the Veins

The main problems that affect the veins include the following:

Abnormal connections between the arteries and veins called arteriovenous fistulas or
arteriovenous malformations, which may be present at birth or develop later in life
Inflammation of a superficial vein due to a blood clot (thrombophlebitis)
Blood clotting within a deep vein (thrombosis)
Defects that lead to swelling (distention) of the vein (varicose veins)

The veins in the legs are particularly at risk of blood clotting or swelling of the vein because
when a person is standing, blood must flow upward from the leg veins, against gravity, to reach
the heart.
NOMER DUA

Varicose Veins of Lower Limbs

Varicose Veins are the ugly looking tortuous dilated knotted veins seen on either sides of the leg
which remain harmless for quite a long time. In the early phases treatment is mostly given for
cosmetic reasons, but later it becomes very distressing by discoloration, edema of legs, eczema,
and recurrent ulcerations around the foot,ankle joints and lower third of legs. Finally it produces
painful non healing ulcers in the vicinity of foot and ankle region. There are mainly two systems
of veins to carry blood from the lower limb to the heart. The most important vein is the Deep
Vein (internal) which is protected by the strong muscles of legs and supported by non-return
valves. If there is a block in this System, it has to bypass the deep vein and resume blood flow
uninterrupted. For this purpose, we have another system, the Superficial Venous System
(SVS) which is called the Saphenous System (see figure No.1) which has no muscular support,
but of course, it has the valvular support. It is just below the skin and hence it is easily visible.
Varicose Vein (VV) usually affects this system of vein which is remaining outside the muscular
compartment of the leg. This system is working only with the help of valves.
When the disease is primarily due to the defective valvular functioning of the Superficial
Venous System (external), we call it Primary Varicose Vein and when it is secondarily involved
due to some block in Deep (internal) Vein it is termed as Secondary Varicose Vein.
NOMER TIGA

Venous insufficiency

Venous insufficiency is a condition in which the veins have problems sending blood from the
legs back to the heart.

Causes
Normally, valves in your deeper leg veins keep blood moving forward toward the heart. With
long-term (chronic) venous insufficiency, vein walls are weakened and valves are damaged. This
causes the veins to stay filled with blood, especially when you are standing.

Chronic venous insufficiency is a long-term condition. It is most commonly due to

malfunctioning (incompetent) valves in the veins. It may also occur as the result of a past blood
clot in the legs.

Risk factors for venous insufficiency include:

Age
Family history of this condition
Female gender (related to levels of the hormone progesterone)
History of deep vein thrombosis in the legs
Obesity
 Pregnancy
Sitting or standing for long periods
Tall height

Symptoms
Pain or other symptoms include:

Dull aching, heaviness, or cramping in legs

Itching and tingling
Pain that gets worse when standing
Pain that gets better when legs are raised

Skin changes in the legs include:

Swelling of the legs

Irritated or cracked skin if you scratch it
Red or swollen, crusted, or weepy skin (stasis dermatitis)
Varicose veins on the surface
Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
Wound or ulcer that is slow to heal on the legs or ankles

Exams and Tests

Your health care provider will do a physical exam and ask about your symptoms and medical
history. Diagnosis is often made based on the appearance of leg veins when you are standing or
sitting with your legs dangling.

A duplex ultrasound exam of your leg may be ordered to:

Check how blood flows in the veins

Rule out other problems with the legs, such as a blood clot

Treatment
Your provider may suggest that you take the following self-care steps to help manage venous
insufficiency:

Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
Care for wounds if you have any open sores or infections.
Lose weight if you are overweight.
Exercise regularly.
You can wear compression stockings to improve blood flow in your legs. Compression stockings
gently squeeze your legs to move blood up your legs. This helps prevent leg swelling and, to a
lesser extent, blood clots.

When more advanced skin changes are present, your provider:

Should explain which skin care treatments can help, and which can make the problem worse
May recommend some drugs or medicines that may help

Your provider may recommend more invasive treatments if you have:

Leg pain, which may make your legs feel heavy or tired
Skin sores caused by poor blood flow in the veins that do not heal or recur
Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)

Choices of procedures include:

Sclerotherapy. Salt water (saline) or a chemical solution is injected into the vein. The vein
hardens and then disappears.
Phlebectomy. Small surgical cuts (incisions) are made in the leg near the damaged vein. The vein
is removed through one of the incisions.
Procedures that can be done in a provider's office or clinic, such as using a laser or
radiofrequency.
Varicose vein stripping, used to remove or tie off a large vein in the leg called the superficial
saphenous vein.

Outlook (Prognosis)
Chronic venous insufficiency tends to get worse over time. However, it can be managed if
treatment is started in the early stages. By taking self-care steps, you may be able to ease the
discomfort and prevent the condition from getting worse. It is likely that you will need medical
procedures to treat the condition.

When to Contact a Medical Professional

Call your provider if:

You have varicose veins and they are painful.

Your condition gets worse or does not improve with self-care, such as wearing compression
stockings or avoiding standing for too long.
You have a sudden increase in leg pain or swelling, fever, redness of the leg, or leg sores.

Alternative Names
Chronic venous stasis; Chronic venous disease; Leg ulcer - venous insufficiency; Varicose veins
- venous insufficiencY

References
Freischlag JA, Heller JA. Venous disease. In: Townsend CM Jr, Beauchamp RD, Evers BM,
Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier Saunders;
2017:chap 64.

Raffetto JD, Eberhardt RT. Chronic venous disorders. In: Cronenwett JL, Johnston KW, eds.
Rutherford's Vascular Surgery. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55.
NOMER EMPAT

Vein disorders in vein valves are very common , but how much do you really know? To learn
how vein disorders are caused, and treated using laser vein treatment options, micro surgery and
vein injection treatment it is important to first understand the venous valves that may be the
underlying cause of spider veins, varicose veins, and venous insufficiency.

About two thirds of the blood in the body is held in the veins and a large percentage of that is in
the leg veins. Delivering blood out to the body is done via the arteries and is helped greatly by
the pumping of the heart. Gravity also helps for those areas that are located below the heart.
However the return of blood back to the heart via the veins is much more challenging and
complex.

The blood in the legs of an adult has to travel upward to reach the heart and lungs. There are also
many obstacles it has to overcome. These include its need to flow uphill against gravity, against
the bodies weight, a distance of up to four or five feet (from ankle to heart) and all without the
benefit of a constant pump like the heart. Fortunately mother nature has helped aid this with the
presence of one way valves in the veins.

These valves are essentially two flaps of tissue located within the walls of the veins and are
scattered throughout the length of the veins. They allow blood to travel towards the heart by
opening as blood is flowing through them. As they are only uni-directional they prevent the back
flow of blood away from the heart. A very good video showing the function of vein valves can
be seen here. This is essential for the circulation as you can imagine its not possible for blood in
the ankle to simply jump up to the heart in one step. With the help of valves it is more of a step
by step northward flow in the leg veins. In varicose veins the valves are often not functioning
meaning that they are allowing blood to regurgitate back into the legs and not advance towards
the heart.

The occurrence of these faulty valves has many underlying causes. These include factors such
as pregnancy, hormonal changes, obesity, increasing age and prior blood clots that can cause
valves to malfunction. A family history of leg vein problems or being born with weak vein
valves also contribute to the problem in some varicose veins patients..

Valves themselves cant be fixed to work correctly but fortunately the treatment of their effects,
varicose veins, spider veins, and vein valve failure, is often done using lasers, vein microsurgery
and injection compression therapy. Also it is always done on an outpatient basis at centers such
as the Schulman Vein and Laser Center in Long Island and New York City.