Introduction and grading of varicose veins
Varicose veins, often called “worm legs,” describe the appearance of swollen, bulging veins and clumps in the legs.
Varicose veins can occur in any part of the superficial veins, mainly in the lower extremities (thighs and inner calves). The reason for this is that the evolution of humans to walk “upright” has added a great deal of pressure to the veins of the lower extremities, increasing the likelihood of vasodilation significantly.
We can differentiate problems with leg veins into three categories based on the appearance, size, and location of the vessels: varicose veins, dilated reticular veins, and dilated microvessels.
For most people, all three of these types only affect their appearance. However, the discomfort and possible complications associated with varicose veins are far more harmful than the other two categories. Some people experience pain, soreness, swelling, and even complications such as dermatitis, eczema, ulcers, blood clots, and bleeding.
The human body’s circulation system consists of four parts: the heart, the arterial system, venous system and capillary, each of which has its own set of rules that guide the direction of blood flow. The venous system relies on special “one-way valves” (valves) in the veins to overcome gravity and carry blood back to the heart.
When blood flows upward, the valves open to allow blood to flow through; when blood flows downward, they close to ensure the proper return of blood upward. The contraction of the calf muscle pump, in combination with the action of the venous valves, helps blood return to the heart from the lower extremities by squeezing the walls.
As a result, once the valves are weak or damaged, blood flows backward (also known as reflux) and pools in the veins of the lower extremities, which over time, causes the blood vessels under extreme pressure to dilate and bend, eventually leading to varicose veins.
- Age: As we age, valve function declines, and aging tends to cause venous valves to wear out.
- Gender: Women commonly have varicose veins. In particular, hormonal changes during pregnancy, pre-menstruation, and menopause tend to loosen the walls of blood vessels and dilate the veins. In addition, hormonal treatments (such as oral contraceptives) may increase the chance of developing varicose veins.
- Pregnancy: In addition to hormonal changes, these changes in a woman’s body during pregnancy, when the amount of blood increases and the subunit becomes more extensive, which are vital to supporting the growth of the fetus, can lead to a rise in pressure or compression of the pelvic veins, resulting in the side effect of “dilated veins in the legs.
- Family history: When other family members have varicose veins, the possibility of having varicose veins will increase.
- Obesity: excess upper body weight can exacerbate pressure on the veins of the lower extremities, significantly increasing the risk of varicose veins.
- Prolonged standing and sitting: When the same posture is kept inactive for a long time, it may cause poor blood return and circulation in the lower limbs, causing varicose veins.
Varicose veins have a slow course and present with a wide range of symptoms, varying in severity. Clinicians can clinically classify varicose veins into seven grades (C0 – C6). The higher the grade, the more severe it is. To understand the stages of varicose vein progression:
C0: No varicose veins.
C1: Refers to dilated capillaries or slender, cobweb-like blood vessels in the legs.
C2: Varicose veins and veins appear as venous aneurysms greater than three millimeters in diameter.
C3: Either of the above with lower extremity edema.
C4: Skin lesions caused by venous disease are present. These include hyperpigmentation, dermatitis, eczema, or skin sclerosis.
C5: C4 conditions plus healed skin ulcers originating from venous lesions.
C6: There are unhealed venous skin ulcers (active venous ulcers).
When to see doctor?
We recommend consulting a doctor early. When symptoms of varicose veins appear in the legs, you should seek the assistance of a specialist for an ultrasound hemodynamic evaluation of the veins in the lower extremities. After receiving a precise diagnosis, follow the doctor’s recommendation to decide if you need treatment and what kind of treatment you should use to avoid the condition deteriorating.