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Glossary for patients

Artery – thick walled vessels through which the heart pumps blood under high pressure carrying oxygen and nutrients throughout the body.

Artery blood pressure is high (normal range 90-140 mmHg)

Vein – thin walled vessels, which carry low pressure blood back to the heart. These are easily compressed by pressure on the skin.

Deep veins – usually lie within the muscles, next to the arteries and cannot be seen without special equipment. These veins are responsible for returning the majority of blood to the heart.

Superficial veins – usually lie in the ‘fatty’ tissue just beneath the skin and can easily be seen on the hands and feet

Vein blood pressure in large veins is very variable 0-120mmHg depending on where it is measured and the position of the body (lying, sitting, standing), the height of the patient and the status of the vein valves. The blood pressure in superficial veins at the ankle is typically 50mmHg sitting and 100mmHg standing.

Muscles in the arms and legs act as vein pump and squeeze veins forcing blood back towards the heart. The most important of these is the calf muscle pump returning blood from the from the legs to the heart.

A number of valves in the veins ensure blood can only flow in one direction back towards the heart.

Valves may fail for a number of reasons such as a genetic disorder or valve damage. If the valves in veins fail blood can flow backwards or reflux, often known as valvular incompetence.

Varicose veins are veins that have become enlarged and tortuous. They are usually found in the leg and are caused by valvular incompetence which reduces the ability of the muscle pump to return blood to the heart and increasing pressure on veins causing them to swell.

Effects of age or reduced mobility – The severity of varicose veins increases with age. In the elderly the calf muscle calf pump is less active, increasing the risk of ankle swelling and leg ulcers.

Superficial thrombo-phlebitis – an inflammation of the superficial varicose veins due to thrombus formation (the varicose vein becomes hard) within the vein. These are painful red lumps on the legs which are tender for 4-5 weeks.  These symptoms can be confused with Deep Vein Thrombosis (DVT) which occurs when thrombus in the deep veins.

Bleeding varicose veins –  often varicose veins are very close to the skin surface and even a minor knock can cause severe bleeding. This is common following a hot bath or shower. This bleeding is easy to control by elevating the leg above the heart and applying a pressure pad (a towel would do).

Severe venous insufficiency – simple exercise, such as walking, normally reduces vein pressure at the ankle by from 100mmHg to less than 40mmHg. On standing still the pressure will normally require over 25 seconds to return 100mmHg. Patients who have severe varicose veins or poor calf pump function suffer swollen aching legs and are at risk of getting a leg ulcer (venous ulcer).

Leg ulcerssevere venous insufficiency causes high vein pressure with swelling of lower limb forming a barrier preventing blood nutrients and oxygen from feeding the tissues. The ability to repair damage and fight off infection is impaired leading to the formation of large open wounds or sores which can become infected, smelly and painful. Typically lleg ulcers can take months to heal.