How is Vein Disease of the Legs Classified?

A Doctor assessing a vein map

Almost all venous disease is caused by faulty valves located in the larger veins of the legs. By design, these valves ensure that blood flows in the correct direction, e.g. up the legs and towards the heart. For a multitude of reasons, these valves can become stretched out or otherwise damaged. As this occurs blood begins to trickle back down the leg and begins to pool. This is known as venous reflux. It’s an ongoing process, and without treatment a patient’s symptoms almost always become worse over time.

As with many medical conditions, venous disease presents in a variety of ways. Those affected may display different symptoms, and cases range in severity from minor cosmetic defects to painful, non-healing ulcers.

How are Varicose Veins Diagnosed?

Before arriving at a proper diagnosis, your healthcare provider will want to take a complete patient history. He or she will take note of your family history and if you’ve had any previous illnesses or injuries that may have affected your veins and/or circulation. Make sure to bring a list of any current and past medications, as well as current supplements, to your appointment. Additionally, it is a good idea to write down a list of any questions or concerns that you might have.

Your doctor will want to perform a complete physical exam. This will include a close examination of your legs while you are standing in order to check for any swelling. Your doctor may use an imaging test (for example a duplex ultrasound) to analyze the flow of blood in your legs, identifying any medical conditions in your veins.

What are the Symptoms of Varicose Veins?

Varicose veins have a variety of symptoms. For many, the most noticeable symptom are the cosmetic issues they cause. However, others experience pain and/or discomfort.

The most common symptoms associated with varicose veins include:

  • Purple or dark blue veins
  • Twisted, twirling veins
  • Aching or a feeling of heaviness in the legs
  • Throbbing, itchiness or burning sensation around the affected veins
  • Swelling
  • Painful sensations after standing or sitting for an extended period of time
  • Ulcers (wounds) on the ankle and leg. (Take special note of skin ulcers as they are indicative of other more severe vascular conditions. You should seek immediate medical attention if ulcers develop.)

What are the Risk Factors for Varicose Veins?

Understanding the risk factors associated with the development of varicose veins, can help you avoid or postpone the onset of the potentially painful condition.

  • Standing or Sitting for Long Periods of Time: Your body’s ability to push blood through your veins is hampered when you remain in the same position for an extended period of time. Moving regularly contracts your muscles and helps move the blood back to the heart. Make sure to move at least every hour or two.
  • Extra Weight: Being overweight or obese places your veins under more pressure and can lead to the development of varicose veins.
  • Advanced Age: As the body ages, the normal wear and tear of your daily routine will weaken the walls and the valves in your veins. These valves regulate your blood flow by keeping it flowing in the correct direction.
  • Gender: Women have a higher probability of developing spider and varicose veins. It is thought that the natural hormonal changes during pregnancy, PMS and menopause play a roll. Estrogen and other female hormones are known to relax the vein walls. Additionally, hormone replacement therapy (which is more common in women) and birth control pills might increase the risk of developing varicose veins.
  • Heredity : If you have close family members with varicose veins, you are more likely to develop them.
  • Trauma to or Injury of the leg: Trauma can cause lifelong physical damage to the veins and the tissue surrounding them. Damaged tissue can lead to long-term vein issues.

Vein Disease is classified using the CEAP system

A graphic demonstrating a normal vein and a varicose vein

Vein disease is presently classified using a six-point scale known as the CEAP system. Prior to CEAP, there was no single method healthcare professionals could use to classify vein disease. Instead, they would simply describe individual symptoms and rate them as mild, moderate, or severe. This approach was inefficient, lacked specificity, and could hamper communication between providers.

Today, CEAP is the accepted standard used by all healthcare professionals when describing lower extremity vein disease. It’s designed to be very specific and facilitate good communication.

How does age impact the development and progression of varicose veins?

Age can significantly impact the development and progression of varicose veins. Here are ways in which age plays a role:

  1. Loss of Elasticity: With aging, the walls of veins may lose some of their elasticity. This can contribute to the veins becoming stretched and less able to efficiently return blood to the heart.
  2. Weakening of Valves: Veins have one-way valves that help blood flow in the correct direction. Over time, these valves may weaken, allowing blood to pool and veins to become enlarged.
  3. Cumulative Effect of Wear and Tear: The cumulative effect of years of standing, walking, and other daily activities can contribute to wear and tear on the veins, making them more susceptible to becoming varicose.
  4. Decreased Muscle Mass: Aging is associated with a natural decrease in muscle mass. The muscles surrounding the veins play a crucial role in assisting blood circulation. Reduced muscle support can contribute to venous insufficiency.

Is weight management important in preventing or managing varicose veins?

Yes, weight management is important in preventing and managing varicose veins. Maintaining a healthy weight contributes to overall vascular health and can help alleviate some of the risk factors associated with varicose veins. Here’s how weight management plays a role:

  1. Reduced Pressure on Veins: Excess body weight can increase pressure on the veins, especially in the lower extremities. This added pressure can contribute to the development and progression of varicose veins.
  2. Improved Circulation: Maintaining a healthy weight promotes better circulation. When circulation is efficient, it helps prevent blood from pooling in the veins and reduces the likelihood of venous insufficiency.
  3. Prevention of Varicose Vein Risk Factors: Obesity is often associated with other risk factors for varicose veins, such as sedentary behavior and a lack of physical activity.

The 7 stages of the CEAP classification system

C0: This describes a fully functioning, healthy venous system. The C0 patient’s leg veins conduct blood back towards the heart exactly as they’re supposed to.

C1: The presence of spider veins can be noted. These web-like clusters of tiny veins are also known as reticular veins. As a condition, the presence of spider veins is known as telangiectasia.

By themselves, spider veins are nothing more than a cosmetic nuisance. They do, however, indicate some level of reflux in the underlying larger veins of the legs. As such, they’re a direct precursor to varicose veins.

C2: The formation of varicose veins. Patients begin to experience more venous reflux as the disease process continues which causes more blood to pool in the legs. This leads to increased pressure, which in turn causes previously invisible surface veins to swell. Over time they become stretched out and can eventually become thick, winding varicose veins.

The C2 stage indicates moderately severe leg vein disease. Many patients begin to experience physical symptoms such as achiness in the legs, swelling, cramping, and a sense of heaviness. Without the proper treatment, it’s highly likely that the condition will progress to the following stages.

C3: The presence of edema. This is the medical term for moderate to severe fluid retention and swelling. Conservative methods such as compression stockings and edema pumps can manage symptoms but won’t help the underlying condition. As with C2 stage and subsequent categories, a patient’s vein disease will almost certainly worsen if not properly treated.

C4: Visible skin changes. Chronic fluid retention often leads to changes in the color, texture, and general appearance of the skin. The presence of eczema and brownish, purplish, or reddish blotches is common in C4 stage patients.

C5: A history of healed ankle ulcers. Left unchecked, chronic fluid retention causes a dramatic increase in pressure within a patient’s leg veins. This in turn can lead to impaired circulation which can cause a breakdown of the overlying skin. C5 stage patients begin to experience painful ulcers, especially around the ankles, which heal on their own without intervention.

C6: Active lower extremity ulcers. Fortunately, only about 1% of all patients with vein disease will progress to CEAP stage 6. As their condition worsens with time, C6 patients begin to form ulcers that won’t heal without specialty wound care. At this point treatment is highly recommended and may indeed be medically necessary.