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Varicose veins, often mischaracterized as a cosmetic problem are actually a sign of an underlying disorder of the circulatory system called venous insufficiency. This condition is an enormous problem in the USA as it afflicts five times as many as arterial disease. By age sixty, 70% of women and 40% of men will suffer from this condition. Left untreated, it can lead to a chronic, debilitating, and sometimes limb-threatening condition.

To understand the treatment of varicose veins, it is important to understand their cause, venous insufficiency. Our circulatory system has four components; the heart, arteries, tissue capillaries, and veins. The heart pumps blood through the arteries to the tissues. Blood filters through tiny capillaries where oxygen and nutrients are delivered. Blood then circulates back to the heart and lungs through the veins.

Whereas the heart pressurizes the blood for the trip to the tissues, this pressure is lost to the resistance of the capillary bed, so the pressure directing blood back to the heart in the veins is low. In the head, arms, and chest, gravity helps pull blood into the heart. However gravity works against the return of blood from the lower half of the body. The return of blood from the legs is directed by a series of one-way valves. When we walk, the veins are compressed as our muscles pump. Blood within the veins moves when they are compressed, and when the valves are working properly blood flows up towards the heart. When these valves leak, gravity wins the battle and pulls blood down. These leaky or insufficient valves are the underlying mechanism of varicose vein disease.

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