Understanding Your Veins

What exactly is vein disease?

Vein disease is a progressive condition characterized by two main problems:

  • Valve Failure
  • Blood Clots

How do vein valves work?

All veins have valves.  These valves have two functions:

  1. When leg muscles contract and squeeze the veins, the vein valves work to keep venous blood flowing one way, upwards, towards the heart.
  2. When leg muscles relax, the vein valves hold up the weight of the column of blood returning to the heart. The valves prevent gravity from pulling the blood in the veins back down the leg and prevent the blood from pooling in the veins below.

Valve failure in veins is the principle problem in vein disease. When the valves do not properly work, blood pools in the both interior and exterior (visible varicose and spider veins) veins in your legs. Our diagnostic evaluation carefully searches for failed valves in all vein systems of each of your legs.

What results from failed vein valves?

  1. Distension (varicose veins and spider veins):  Failed valves can no longer hold up the column of blood under gravity. When blood pools below under pressure, this causes the veins to swell with excess blood (varicose veins, red spider veins, blue reticular veins).  Pain, heaviness, tired and ‘older feeling’ legs result from the distension of hidden varicose veins (90% of varicose veins)….veins too deep to see from the outside but clearly visible on ultrasound.
  2.  Leakage (swollen ankles, discolored skin, and night cramps):  Pooled blood under pressure causes leakage from venous capillaries of fluid, blood cells and protein.  This causes sickened skin, discoloration, edema/swelling, night cramps, forms of restlessness, skin ulcers, recurrent infection, venous eczema, chronic swelling of lymphedema.
  3. Stagnation (blood clots):  Pooling below failed valves causes dilation of vessels and stagnation of blood flow, increasing the risk of blood clots.

Why are blood clots in veins dangerous?

Blood clots in the superficial vein systems (above the muscle) are painful and people with these clots have an increased risk of deep vein clots (below the muscle). Deep vein clots (Deep Vein Thrombosis – DVT) are very dangerous – they can break free, pass through the heart and lodge in the lungs (Pulmonary Emboli – PE).  These can be lethal. Some studies suggest they kill as many people each year as do heart attacks. Part of our diagnostic workup is to search for vein blood clots.

Are my symptoms from vein issues?

The symptoms listed below are often the cause of vein issues. If you are experiencing one or more of the following symptoms you will need a consultation and ultrasound evaluation at Mountcastle Vein Centers to determine if vein issues are the cause.

Leg Pain and Restlessness

leg-pain-restlessnessAching, Heavy, Tired,  or “Old” feeling Legs are often caused by distended varicose veins inside the leg.  Though easily found on ultrasound, 90% of these veins are invisible on visual inspection of the leg.

While there are forms of restlessness with origins in the brain, many are considered “secondary” to origins of vein valve failure. This cause is very treatable and should be looked for before embarking on a lifetime of dopaminergic medication acting directly on the brain.

Surface Varicose, Red Spider Veins, Blue Reticular Veins

surface-varicose-veins1 surface-varicose-veins2

These are caused by dilation of veins below failed valves.  It is important to first fix the source of the problem, then treat the visual problem.  To treat spider and reticular veins without searching first for the root cause is foolhardy.  Varicose veins are not just unsightly; they cause aching, recurrent thrombophlebitis and increase the likelihood of deep vein clots.

Night Cramps


Veins under pressure from failed valves leak fluid.  As this fluid returns to the vessels at night when lying down, the cell membranes are altered making muscles quick to contract.   And, the brain sends messages to the legs (usually both legs and to flexor and extensor muscles at the same time) to move, to pump congestion from the legs….the result is an often severe “night cramp”.  90% of night-time leg cramps after fifty are caused by vein problem, only 10% by low potassium, calcium or magnesium.

Itching and Burning, Reddened, Hot Skin, Ulceration, Recurrent infection, Venous eczema, scaling skin

reddened-ulceration1 reddened-ulceration2 reddened-ulceration3
With valve failure there is leakage of fluid, blood cells and protein.  The skin often becomes inflamed, itches, burns, and becomes reddened and hot. The sickened skin no longer serves as a barrier to infection and can even breakdown and ulcerate.


Discolored skin

Veins under pressure leak blood cells.  The accumulated hemoglobin stains and tattoos the skin leaving discoloration.


Swollen Ankles and Lymphedema

swollen-ankles-lymphedemaVeins under pressure leak fluid and protein.  This causes the swollen ankles and feet at the end of the day that are often observed in people with vein disease.  Lymphatics are a very important circulatory system, drop-by-drop they remove a gallon of fluid from each of our legs every day. Over time, as lymphatic channels are constantly strained by leaked fluid, they become stretched, clogged with protein, and cease to function.  The swelling is then constant and no longer goes away at night.  In patients over age fifty, 90% of this leakage is caused by vein problems and only 10% is caused by heart, renal, and liver failure.   The solution is to fix the source of the problem, the veins, with the treatments provided at Mountcastle Vein Centers instead of treating only the symptoms with a lifetime of palliative water pills and pressure stockings. Often we find that this swelling in vein disease is indeed the cause of patients’ complained of “pain,” rather than strains/hernias in groin pain, arthritis in knee pain, and diabetes in neuropathy as primary doctor’s commonly believe.

What else could be causing my signs and symptoms?

Prior to your treatment our doctors at Mountcastle Vein Centers, in collaboration with your primary doctor, will search for alternative explanations for your symptoms including sciatica, spinal stenosis, arthritic hips and knees, heart-renal-or liver failure, dermatological conditions, arterial insufficiency, primary restless leg syndrome and other problems.

Why do my legs or ankles hurt?

Pain, aching, heaviness, tiredness, and “old” feeling in the legs is often caused by the distension (swelling) of veins within the leg.  When vein valves fail they can no longer hold up the weight of the column of blood.  The blood falls under gravity downwards toward the feet.  The veins below, under increased pressure, dilate and press on the nerves causing pain.

Night cramps are also painful and experienced from vein disease.  All day fluid builds up in the veins below broken valves.  At night the brain tells the muscles to move in order to pump the built-up fluid out of the legs.  Unfortunately both flexor and extensor muscles are activated and the result is a “Charley Horse”, a severe and painful cramp felt by the patient.

What is wrong with my legs?

At Mountcastle Vein Centers we first review your signs such as surface vessels (varicose veins, spider and reticular veins), blue veins at the instep, skin changes, and swelling. We review your symptoms (pain, swelling, cramps, itching, burning). We then do a very careful ultrasound of the veins and arteries of each leg. This evaluation will tell us if vascular issue and vein disease are the source of your problems.

How can I make my legs look better?

Mountcastle Vein Centers offers safe, effective, and state-of-the-art cosmetic vein treatments, including VeinGogh radiofrequency treatment and Sclerotherapy injections, for veins visible on the leg’s surface. To make your leg’s look better, Mountcastle Vein Center recommends the following steps:

  1. Have a full ultrasound workup. Simple surface radiofrequency or sclerotherapy treatments of spider veins is doomed to failure if deeper problems are present and not treated. When deeper problems, if present, are addressed, the long-term success of cosmetic, surface improvements is greatly increased.
  2. Have the modern treatments. Avoid vein stripping, surgical treatment of varicose veins, and saline injections. These old treatments can all cause scarring and make your legs look much worse. Mountcastle Vein Centers uses non-surgical, elegant procedures with state-of-the-art technology for all cosmetic and medically necessary vein problems.
  3. Do not procrastinate. After vein valves fail the legs continue to slowly but relentlessly deteriorate. If not treated, small areas of redness inevitably become large areas of discoloration and staining. If not treated, end-of-day leg/ankle swelling becomes persistent lymphedema and/or Corona Phlebectasia (blue veins at the ankle). If not treated, fine spider veins proliferate and enlarge to become much larger, blue reticular veins.

Why do I need and ultrasound evaluation for a cosmetic problem?

The key to successful and longer-lasting cosmetic treatment of your legs is treating the root causes of your problem. Simple treatment of superficial problems with disregard to their source is the main reason for treatment failure and return of cosmetic problems. “Medically Necessary” treatment directed at the source of problems such as pain, swelling, skin breakdown and bleeding often results in significant “cosmetic” improvement even when cosmetic-specific treatments are not received.