The most common clinical presentations of venous insufficiency include spider veins and varicose veins. Spider veins are smaller, more superficial veins, resulting in a network of red and purple spider web like marks on the legs. Varicose veins are larger, swollen, blue and purple ropey veins easily visible on physical exam. Large varicose veins may throb; hurt or itch and on occasion may clot off or bleed through the skin. Varicose veins occur when the one way check valves in the superficial system of veins fail to close tightly. The veins just under the skin begin to bulge under this increased pressure and eventually the skin stretches and allows the veins to continue growing.
A significant number of the estimated 35-40 million adults in the United States suffer from this unsightly and often painful presentation of venous insufficiency. Patients with large swollen varicose veins may also complain of heavy, swollen, tired, restless or achy legs. Sitting or standing in the same position, such as during work, can cause worsening of the symptoms throughout the day. Left untreated, the condition generally progresses, with continued enlargement of the veins and thinning of the overlying skin. This can lead to erosion of the overlying skin and varicose vein bleeding or ulcerations.