What is Saphenous Vein Reflux?
Saphenous vein reflux is the condition that leads to the majority of cases of varicose veins of the legs. “Saphenous” refers to a particular type of vein in the leg that lies in the superficial compartment of the leg, just beneath the surface of the skin. The saphenous veins cannot be seen by the naked eye, as they lay in the fat layer of the leg between the skin and the muscle. But when these saphenous veins are diseased, they cause varicose veins to grow off of them. The abnormal vein branches that grow or emanate from the saphenous veins are visible at the surface as enlarged, bulging varicose veins.
Everyone has saphenous veins in the legs. But these veins are usually healthy and productive veins and function to return deoxygenated blood back to the heart. Healthy veins are able to push the blood against gravity and towards the heart by the use of a series of vein valves within the vein lumen. The valves act as a continuous moving “conveyor belt” that keeps blood flowing in the right direction.
But in patients with diseased saphenous veins, the valves stop working properly. The diseased vein valves fail and snap, allowing blood to travel backward (in the wrong direction towards the foot). In this situation, gravity “wins” and the valves “lose.” This backward blood flow that results from broken vein valves is referred to as venous reflux disease or chronic venous insufficiency.
The backward blood flow, i.e. venous reflux, causes the pressure within the saphenous veins to rise to an abnormally high level. As the pressure rises, even more valves snap and fail and the veins begin to stretch and enlarge. In order to decompress this high abnormal pressure, the body finds new abnormal pathways for the blood to travel. This abnormal high-pressure flow in the leg veins begins to cause the surface veins to bulge and become varicose. The high-pressure build-up in the leg veins also leads to many abnormal symptoms in the legs, including aching, swelling, burning, heaviness, cramping, fatigue, itching, etc. If allowed to progress for too many years, these abnormal saphenous veins can cause serious circulation problems in the legs. Some examples of more serious manifestations of vein reflux are severe leg swelling, leg asymmetry, venous ulcers or wounds in the ankles, severe skin damage, severe dermatitis, bleeding from the skin, blood clots, browning of the skin of the ankles and foot, and nerve damage/neuropathy.
Is There More Than One Saphenous Vein in the Leg?
Yes. There are several saphenous veins in each leg. Saphenous vein reflux most commonly affects a single saphenous vein in the leg, a vein called the great saphenous vein. Other saphenous veins in the leg that can be affected by vein reflux include the small saphenous vein (also referred to as the short saphenous vein), the anterior accessory saphenous vein, and the posterior accessory saphenous vein (also referred to as the Vein of Giacomini). These other veins are less likely to have reflux disease, as the great saphenous vein has the strongest genetic predisposition to valve failure. Valve reflux can often spread from the great saphenous vein to other saphenous veins in the leg over time. This is one reason why it is important to have your varicose veins and your leg symptoms evaluated sooner rather than later. As the valved reflux spreads through the leg it often becomes more difficult to treat the disease process.
What Causes Saphenous Vein Reflux to Develop?
There can be many causes of vein reflux of the legs. But by far, the most common reason that it develops is the inheritance of the gene for the condition. The condition is a genetically inherited trait with high penetrance. This means that most people with the condition inherit it from their parents or grandparents. Most people with the condition have at least one member of their immediate family, such as their parents or siblings, that also have the condition.
Other reasons that people may develop venous reflux are a history of trauma to the legs or a history of blood clots, both of which can cause physical damage to the leg veins. It may take years from the time of the trauma or clot before varicose veins or leg vein symptoms develop.
What Can Cause Saphenous Vein Reflux to Worsen and Become More Symptomatic?
Certain conditions can cause saphenous vein reflux disease to progress more rapidly. One example is pregnancy. Pregnancy tends to significantly accelerate the progression of venous reflux disease and varicose veins. Another example is occupations in which there is prolonged standing involved, such as being a cashier, hairdresser, cosmetologist, or bank teller. Another reason the disease may progress is being overweight or obese.
How Do I Figure Out If I Have Saphenous Vein Reflux?
The only way to determine if you have vein reflux is to seek consultation from a board-certified vein specialist (preferably a Vascular Surgeon). The physician will first examine your legs and look for obvious signs of the disease. If there is a suspicion that you are having vein reflux (based on your symptoms and your physical examination), then the doctor may recommend a special type of vein study referred to as a venous reflux ultrasound. If this study is performed by a qualified individual, then the study will be able to definitively determine whether you have significant saphenous vein reflux.
Our experience with venous reflux testing is that the tests should only be performed by highly trained individuals with many years of experience in such testing, as it takes significant skill and expertise to do the exam properly. Our recommendation is to always have the venous reflux ultrasound performed at a Vascular Center by a Registered Vascular Technologist (RVT) or a Registered Physician in Vascular Interpretation (RPVI). We have seen many inaccurate exam results when they have been performed at other facilities. Both our RVT and our RPVI have performed and interpreted thousands of these studies. We are extremely confident of the accuracy of these exams when they are performed in our Vascular Ultrasound Lab.
Saphenous Vein Reflux Therapies
There are several interventional approaches as well as more conservative approaches to treating saphenous vein reflux. A non-procedural approach typically involves the use of support stockings, leg elevation, exercise, and nutritional supplements. Although this approach will not resolve the condition, this more conservative approach can significantly slow the progression of the disease and also help the symptoms to improve. This approach is often recommended for milder forms of the disease.
An interventional approach to venous reflux disease seeks to cure or completely resolve the condition. Interventional therapy is typically reserved for patients with moderate to severe cases of saphenous vein reflux. Many cases of saphenous reflux can be completely cured with interventional therapy. The interventional therapies seek to close the defective saphenous vein(s), causing the blood to re-route into the healthy vein pathways. These therapies have a very high success rate of over 95%. Medical studies have shown that the circulation adapts very well to the closure of defective saphenous veins, causing the circulation to return to normal in the majority of individuals treated.
Saphenous vein reflux treatment techniques include the following:
- Radiofrequency ablation of the defective saphenous vein using the Venefit ClosureFast catheter
- Laser ablation of the defective saphenous vein using the Endovenous Angiodynamics Venacure EVLT catheter
- Chemical ablation of the defective saphenous vein using VenaSeal glue
- Chemical ablation of the defective saphenous vein using Varithena foam
- Mechanical-chemical ablation of the defective saphenous vein using the Clarivein device
- Traditional Open Surgery where the vein is surgically removed (i.e. vein stripping). This is rarely needed.
Which interventional therapy is best for your particular condition and anatomy should be determined by a board-certified Vascular Surgeon. It is important that you seek a consultation from the correct board-certified specialist before deciding on which method of saphenous vein treatment to pursue.
Where to Seek Treatment
If you are interested in either evaluation or treatment for saphenous vein reflux, always seek expert opinion from a board-certified Vascular Surgeon. Austin Vein Specialists only utilizes board-certified Vascular Surgeons. Vascular Surgeons are considered the most highly trained vascular and vein specialists, as they typically have undergone formal residency and fellowship training in the diagnosis and management of all forms of venous diseases. Vascular Surgeons are able to offer you all potential treatment options available for your condition, including minimally invasive options as well as surgery when necessary. It is always wise for you to confirm that your vein physician is board-certified in vascular disease management. This can be done through the Texas Medical Board, the Travis County Medical Society, the American Board of Surgery, or through the Society for Vascular Surgery.
To contact Austin Vein Specialists for questions or to arrange a consultation, please call (512) 339-9100.