A vein is a kind of blood vessel that brings deoxygenated blood from different parts of the body back to the heart. Compared to arteries, veins have thinner walls and are less muscular but they also have valves that aid in the flow of blood back to the heart, especially against gravity.

Similar to arteries, the walls of veins are made up of three layers: the tunica adventitia (outermost layer), the tunica media (middle layer), and the tunica intima (innermost layer).

Common Venous Problems and Conditions

  • Venous insufficiency – Recognized as the most common venous disorder, this is characterized by vein damage caused by wear and tear. The valves of the veins become incompetent, resulting in reflux, and the walls tend to lose their elastic properties, leading to dilatation and varicosities. Stasis of the blood can also produce hyperpigmentation or darkening of the skin. In severe cases, chronic venous insufficiency can result in edema of the legs and non-healing wounds.

  • Venous thrombosis – This is a condition wherein a blood clot develops in a vein. This usually affects veins of the lower extremities, producing swelling and pain. The most dreaded complication of deep venous thrombosis is pulmonary embolism, wherein part of the venous clot breaks off and lodges into the lungs.

  • Portal hypertension – This is a condition characterized by the presence of increased pressure in the portal venous system due to liver disease or cirrhosis. Portal hypertension results in the development of collateral circulation, producing visible and enlarged veins, such as hemorrhoids and esophageal varices.

Common Venous Procedures and Surgeries

  • Duplex ultrasound – This is one of the most common diagnostic methods used to visualize veins wherein sound waves are utilized to create an image of the vessel.

  • Sclerotherapy – Sclerotherapy is the injection of a specific solution into a vein. This results in the irritation of the lining of the vein and clot formation. The procedure is typically recommended for the treatment of varicose veins.

  • Surgery for venous insufficiency – There are a variety of surgical options for the management of venous insufficiency and varicosities. One is vein stripping that involves the removal of the great saphenous vein in order to decrease venous hypertension. In recent years, less invasive techniques have been developed for the same purpose of obliterating the great saphenous vein. These include endovenous laser therapy and radiofrequency ablation, to name a few. Surgery for venous insufficiency is usually reserved as a last resort for progressive symptoms or for cosmetic reasons.

  • Central venous catheter insertion – Insertion of a catheter into a major vein (such as the internal jugular vein or the subclavian vein) can be performed for central access and monitoring, hemodialysis, parenteral nutrition and chemotherapy, among others.

  • Vein harvest – The great saphenous vein is one of the most commonly used native conduits or grafts for different kinds of vascular surgeries. Harvesting the great saphenous vein is usually performed for coronary artery bypass grafting.

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