What is the Difference Between Large Vein Disease and Medium Vein Disease?

Today we are going to look at the different veins affected by varicose vein disease and how they make your legs look and feel. We’ll also review who is most at risk for developing vein disease. Read on to learn more about large vein disease (or varicose vein disease) and medium vein disease (or spider vein disease).

How does the venous circulatory system work?

In a healthy venous circulatory system, veins are tasked with picking up carbon dioxide as well as waste products from the cells and carrying them back towards the heart. This is done through a series of one-way valves along the pathway of the veins in the leg, along with contraction of the calf muscles when we walk and move, allowing blood flow to move against gravity and back towards the heart and lungs. When the venous valves fail, blood flow can no longer drain out of the veins properly. This leads to blood pooling in the veins of your legs, causing them to stretch until they become the varicose veins we all know but don’t love. This process of failed valves and backwards blood flow is known as varicose vein disease or chronic venous insufficiency (CVI).

What do the acronyms MVD and LVD stand for?

The venous system is made up of different types of veins including what we in the field call “large veins” and “medium veins.” When these systems are diseased, we refer to the process as “large vein disease” or LVD and “medium vein disease” or MVD. When you think of the veins, think of a tree: the trunk of the tree (truncal veins or saphenous veins), as well as the branches (varicose veins) are what we refer to as large veins. The small branches and leaves (reticular and spider veins) are referred to as the medium veins. Essentially, the entire tree, or all portions of the superficial venous system can be affected by varicose vein disease or CVI.

Use the chart below to see the different types of vein disease:

How vein disease looks and feels

One of the things most people don’t realize when it comes to vein disease is that looks aren’t everything. Although some patients have visible bulging varicose veins, or visible spider veins, they may also have seemingly mild symptoms. Other patients might have legs that are free of any visible veins and yet suffer with significant symptoms. In fact, that is my story. A few spider veins behind my knee and at my ankle, otherwise healthy-looking legs but terrible symptoms for years until I began working in this field.

A few of the common vein disease symptoms I experienced were:

• • Achy legs
  • Pain around the legs, ankles and feet
  • Swelling at the end of the day and leg restlessness at night

Once I learned about chronic venous insufficiency, I put two and two together, and sought vein treatment.

Signs (what you see) and symptoms (what you feel) of vein disease

While both sides of the vein disease spectrum do exist, the reality is most people are somewhere in the middle. For that reason, it’s important to be aware of the signs and symptoms associated with vein disease to determine if an ultrasound is needed to evaluate the superficial veins in the legs. While you might not be able to see these with your eyes, proper use of ultrasound in the well-trained hands of a vein doctor can help identify the source and extent of large vein disease (LVD).

Some of the more common signs and symptoms of large vein disease to be aware of include:

• Aching
• Pain
• Heaviness
• Throbbing
• Cramping
• Restlessness
• Skin discoloration in the calves and ankles
• Ulcers
• Swelling
• Spider veins
• Bulging varicose veins

A deeper dive into medium vein disease (MVD), or spider veins

MVD, or medium vein disease, is better known as spider veins. This is chronic venous insufficiency that affects the veins at the surface of the skin. These are known as reticular veins (the greenish/blue veins you see just beneath the skin), as well as telangiectasias (fancy name for spider veins, those pink, red, and purple veins you see at the surface of your skin).

Despite appearances, spider veins have often been thought of only as a cosmetic issue. Oh how wrong we have been. Did you know that despite their size, spider veins can often be very symptomatic because they sit closer to the surface of the skin where most of your nerves live? I can tell you from personal experience the itching, aching, restlessness, and cramping caused by spider veins is very real.

The longer you have spider veins, the more at risk you become for more serious vein conditions including skin ulcers, dermatitis, and chronic aching. The good news is spider veins can be treated easily and effectively with sclerotherapy, which is a series of small injections. In most cases, 3-4 treatments are required and the outcome is amazing!

A deeper dive into large vein disease (LVD), or varicose veins

LVD or large vein disease affects the large named veins (saphenous veins), as well as the branches (remember the tree analogy?) which, if left untreated become varicose veins. Large vein disease may be present in those with MVD; in fact, a collection of spider veins at the ankle is often the first sign of underlying LVD. You may be wondering why some patients with large bulging veins have no symptoms. Often, patients with advanced varicose vein disease have been living with it for many years, maybe even decades. The symptoms they feel become “normal” to them. We will often hear them say “doesn’t everyone have swelling at their ankles at the end of the day?” or “doesn’t everyone have tired legs at the end of the day?”. Once we have them try wearing compression stockings, they realize what healthy circulation feels like and realize their “normal” pain is not “normal” after all.

There are several treatment options for large vein disease. All options are minimally invasive, can be performed in the office, and you are encouraged to return to work, and most normal activities right away!

What causes medium vein disease and large vein disease?

You may be wondering what puts you at increased risk for chronic venous insufficiency. Often, we say that there is always someone to thank for the gift: usually your mom, dad, or other family member.

Some common risk factors of vein disease include:

• Genetics: If your parents have vein disease, you will most likely develop it as well. It is also possible for you to be genetically disposed to developing varicose vein disease if your grandparents and siblings have vein disease.
• Gender (female): Women’s hormones play a large role in developing varicose vein disease. Which leads to the next two bullet points:
• Pregnancy: Blood volume nearly doubles during pregnancy; this, along with the significant fluctuations in progesterone leads to varicose vein disease.
• Menopause: This is another time in a woman’s life when hormones significantly fluctuate, laying the foundation for varicose vein disease.
• Age: With increased age, venous valves, and vein walls weaken, paving the way for vein disease.
• Obesity: Additional pressure on the veins due to increased weight can cause varicose veins.
• Standing for long periods of time: With venous flow fighting against gravity for years and years of standing it can increase the risk of LDV and MVD.
• Long periods of inactivity: The contraction of our muscles is what propels venous flow out of our legs and black towards our heart. With long period of inactivity, over time, the blood can pool, causing vein walls and valves to weaken, which puts you at risk for varicose vein disease. Remember: sitting is the new smoking. Get up and walk around throughout the day!
• Injury/Trauma: Knee and hip replacements, other surgeries, vehicle accidents, and sports injuries can put you at risk for varicose vein disease.

Most often, one of the risk factors listed above will not lead to varicose vein disease. However, when speaking with patients, we realize that many of them have several of the above listed risk factors. Do you?

Take control of your vein health

The good news is, if you think you may suffer from vein disease you are not alone! In fact, roughly 1 in 10 Americans suffer from LVD and/or MVD. Do you see any of the above listed signs or experience any of the symptoms but aren’t sure if you have LVD or MVD?