Brief anatomical and physiological features of the venous system in the lower extremities and the development of varicose vein disease

The main function of the venous system in the lower limbs is to return blood from the lower extremities to the heart. This moves the blood against the Earth gravity. Our body has 3 major venous system mechanisms that overcome forces of the gravity and push blood through the veins to the heart.


    1. Muscle and cardiac "pump" – involving the leg muscles and the right heart. It is contractions of the muscle groups in the legs, their changing tone  that pushing the blood upward as well as a upward suction force of the heart and chest to provide the correct flow of blood from the lower extremities.

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  1. Venous valves – small flaps inside the veins. With the compression of calf muscles, veins are also compressed and the blood is pushed higher. In the phase of muscle relaxation veins dilate which causes the blood to rush down. The valves close at that time and prevent reversal of the blood flow. Venous valves work depends entirely on the health of the veins. When these valves close incompletely, a reflux (reversal of blood flow) occurs, thus allowing the blood to flow down. This causes the development of varicose veins.


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  1. Residual blood pressure and tone of venous walls – located near the deep veins are arteries where the blood flow moves quickly and has a pulsating character. This is a result to the proximity of the arteries to the veins and the pressure on the veins which causes a throbbing and also affects the proper outflow of venous blood.

The entire venous system is divided into 3 groups:

  • Superficial veins are located under the skin surface in the bulk of the subcutaneous fat.
  • Deep veins – are deep and close to the arteries.
  • Perforating veins – are "bridges" connecting the superficial and deep veins.

Superficial veins collect blood from the superficial tissues and move it to the deep venous bed. Thus 85 – 90% of the blood flow passes through the deep veins and only less than 10% through superficial veins. Any excess of the venous blood is discharged into the deep veins. This is due to the presence of the perforating veins-bridges.

Varicose vein disease depend on the number of factors: heredity, obesity, lifestyle (including weight lifting, long periods in a fixed position while standing or sitting), dis-hormonal state (including those related to long-term use of hormonal birth control), and pregnancy. Those factors lead to a reduction in the tone and elasticity of the venous wall, damage venous valves, increase pressure in the venous system, and causes expansion of the superficial veins.

As a result, a vein increases in size significantly, and slowly varicose veins develop. In addition, damaged venous valves do not function properly. This leads to reflux (back-flow of blood) that accumulates in the veins which leads to further expansion of these vessels and the further development of varicose veins. In the absence of proper treatment of varicose veins a patient can develop complications such as thrombophlebitis, skin changes and venous ulcers.

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