The skin and soft tissues become fibrotic and tight, causing the lower legs to become narrow and hard, referred to as lipodermatosclerosis. The skin becomes dry and inflamed, referred to as venous eczema. Pooling of blood in the distal tissues results in inflammation. This gives a brown discolouration to the lower legs. The haemoglobin in this leaked blood breaks down to haemosiderin, which is deposited around the shins in the legs. When blood pools in the distal veins, the pressure causes the veins to leak small amounts of blood into the nearby tissues. This leads to dilatation and engorgement of the superficial veins, forming varicose veins. When the valves are incompetent in these perforators, blood flows from the deep veins back into the superficial veins and overloads them. The deep and superficial veins are connected by vessels called the perforating veins (or perforators), which allow blood to flow from the superficial veins to the deep veins. When the valves become incompetent, the blood is drawn downwards by gravity and pools in the veins and feet. The valves prevent gravity from pulling the blood back into the feet. In the legs, as the muscles contract, they squeeze blood upwards against gravity. Veins contain valves that only allow blood to flow in one direction, towards the heart. They are also known as spider veins or thread veins. ![]() Telangiectasia refers to dilated blood vessels in the skin measuring less than 1mm in diameter. Reticular veins are dilated blood vessels in the skin measuring less than 1-3mm in diameter. Varicose veins are distended superficial veins measuring more than 3mm in diameter, usually affecting the legs.
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