Varicose Veins: Causes and Classification

in the veins of the lower limb. In a limb that is unable to empty itself adequately, the distal venous pressure (at the lower extremity) increases, and consequently the fluids in the periphery must be disposed of by other systems.

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There is, therefore, a compensation of the lymphatic circulation that tries to empty the stagnation caused by stasis; in this case we are in a clinical situation in which edema is not yet present.

When the situation of stasis persists and the lymphatic system is no longer able to cope with the load to be removed, there is the appearance of edema due to the extravasation of fluid from the venous vessels into the subcutaneous tissues. In this case, venous hypertension continues to increase, causes micro-haemorrhages, with the leakage of red blood cells, and precipitation of hemosiderin (the iron contained inside the red blood cells that burst), which causes hazel-colored patches. In addition, mechanisms are also set in motion. inflammatory diseases due to the stagnation of proteins, which come out together with the liquid, and which make the situation evolve from phlebosis (venous inflammation) to subcutaneous fibrosis.

Thus, three stages of the disease are identified: a first stage in which the disturbances are compensated, a second in which there is "edema and" hyperpigmentation (hazelnut skin patches), and finally a third stage characterized by ulceration and fibrosis, in when this stage is present hypoxia (reduced oxygen supply) or anoxia (lack of oxygen) of the tissues with severe cellular suffering.

It is important to know that the venous system has the lymphatic system on its side, which can help it. When the lymphatic also becomes saturated, diseases develop. Today these diseases are called phlebo-lymphatic, precisely to underline this link between the venous and lymphatic systems.

Reticular varices, affecting the branches afferent to the Safenae (which flow into the Safenae);

Telangiectasias or microvarices, which are dilations of the venules, the most terminal portions of the veins.

As we move away from the major vascular axes we have increasingly smaller varicose veins up to the varices of the dermis (under the epidermis, which is the first layer of the skin).

It is not certain that they all exist at the same time but they can also exist individually, since one is not an evolution of the other. You can therefore have various frameworks.

Commonly, varicose veins are said to be primitive when a precise cause is not recognized, and they are the majority, although it is possible to identify a series of previously listed "risk factors" responsible for their appearance (erect position, obesity, female sex, pregnancy); in rare cases the varices are secondary to other diseases, generally quite serious, such as for example in the post-thrombotic syndrome, ie the evolution over time of a deep vein thrombosis. The stasis of venous blood can lead to the formation of a thrombus over time superficial or deep venous, which is a cluster of red blood cells, platelets and fibrin.
Deep vein thrombosis is the most dangerous, especially since the thrombus can break off, go to the pulmonary circulation and cause death from pulmonary embolism (obstruction of the pulmonary circulation).
After the onset of a deep vein thrombosis there are three possibilities:

The thrombus does not recanalysis, so an obstructive syndrome is created.
The thrombus is recanalized but there is valve damage and the blood flows back into the deep venous system.
Mixed syndrome with thrombotic and valvular situations.

All this over time determines the post-thrombotic or post-phlebitic syndrome.