At Aurses Health Care, we focus on educating our patients about the basic anatomy of veins and their functions. A common yet false assumption that we encounter routinely is that many think of veins as blood vessels responsible for perfusing a limb or an organ.

We regularly get questioned by patients if the leg or arm veins help bring blood flow into the legs, feet, arms, or hands. Some patients think operating to remove varicose veins can result in a lack of blood flow in the legs or feet. This is why we believe that the public knowledge about blood vessels in Los Angeles and beyond needs to improve.

As a vascular surgeon, Dr. Taheri seeks this opportunity to make it his lifetime mission to educate the public about the human blood vessels' basic anatomy and functions. It is essential to educate the public about vascular health and what they can do to keep their blood vessels healthy.

A cell is the most basic living structure in our body. Our body is made out of billions of cells, which are neatly organized into different groups. However, all cell work intricately together to make our bodies function and form who we are.

Every cell in our body must receive oxygen and nutrients to rid themselves of metabolic byproducts in order to survive. It is the primary responsibility of our blood vessels, the arteries, and the veins to carry the required basic metabolic requirements in and out of the cell. Arteries are designed to perfuse the entire body with oxygenated blood, nutrients, signaling factors, and hormones from the heart to every single cell in the body. Then, these arteries split up into billions of smaller blood vessels called capillaries. The capillaries are single-cell channels that directly bring oxygen, nutrients, and many other substances into the cells, remove metabolic waste, and lead deoxygenated blood back to the vessels called veins. Veins are specialized vessels that carry deoxygenated blood and metabolic waste from the tissues and organs back to the heart. At any given time, about 2/3 of the total blood volume is within the venous system. The histology of veins is very similar to that of arteries, except for a thinner wall due to a lower muscle mass when compared to arteries; hence, they can expand more or have a larger volume capacity than arteries. The blood flow within the veins has less pressure but a better flow compared to the arteries. This explains why we don't feel any pulsation on the veins, and why they are easily compressible, unlike arteries. You can usually spot< the veins on the back of your hands or the top of your feet. They are blue-looking vessels for a person with a fair skin tone. Veins of the extremities are divided into three different categories. Microcirculation, such as superficial plexus and capillaries, collects blood from the arterioles (small arteries) and they drain the blood into small veins call venules. The second groups are superficial veins located between the skin and muscle fascia. The deep veins are located under the muscle fascia and run next to the major limb muscles. At any given time, the deep veins drain about 80% to 90% of the total blood flow from a given limb.

Our staff in both of our locations – in Los Angeles just as much as in Long Beach – thoroughly believes it is important for patients interested in vein treatment to understand that the superficial veins drain about 10% to 15% of the total blood flow. The rest will be exhausted by the lymphatic system – a network of interconnected channels – which drains the extra fluid within the superficial tissue and plays an important part of the immune system. There are two large superficial veins with similar names in the lower extremities: the greater saphenous vein (GSV) and the lesser saphenous vein (SSV). The GSV is a large vein that starts on the top of the foot and travels just above the bony medial malleolus, then goes up the leg and connects to the common femoral vein located just below the groin. GSV has many branches. Some of these branches communicate with the deep veins called perforator veins since they pierce through the muscle fascia from superficial to deep veins.

The perforator veins are mainly located around the medial ankle, lower and upper medial calf, and lower and upper medial thighs. GSV also has many side branches responsible for bringing the blood from the skin and the fatty tissues into the GSV. The SSV is located over the back of the calf. They usually run from the lower part of the calf and drain into the deep vein (popliteal vein) just behind the knee joint. The deep veins are located deep and are sandwiched by major muscle groups, and are not visible by naked eyes. These veins are posterior tibial, peroneal, soleus, popliteal, femoral, deep femoral and common femoral veins. The common femoral vein drains into the iliac veins in the pelvic. The Iliac veins drain into the inferior vena cava (IVC), which also drains blood from many internal organs, such as the kidneys, liver, adrenalin glands, and gonad, back into the right side of the heart. This side of the heart pumps the blood into the pulmonary arteries to the lungs for oxygenation. The upper extremities have a very similar system to the lower extremities. The superficial veins of the forearm and upper arms are the cephalic and basilic veins, while the deep veins are radial, ulnar, brachial, axillary, subclavian and innominate veins. The upper extremities’ veins drain to the superior vena cave (SVC) and then into the right side of the heart. Generally, all four limbs – especially the lower extremities – use the distal muscle groups – such as calf muscles – as pumps, therefore forcing the blood through the veins toward the heart. All the veins in our extremities have small bicuspid (two leaflets) valves, which prevent blood flow from moving backward. These valves play an essential role in keeping the blood flow in one direction. If these valves do not close properly, the blood will leak across them backward, and the segment below will be congested. Over time, this congestion will lead to dilated side branches and perforators, forcing them to increase their diameter and length, particularly the smaller branches' side branches. Many of our Los Angeles and Long Beach patients are confronted with this case, and their veins will eventually serpentine under the skin with large lumps. We refer to these as varicose veins.

Varicose veins are diseased nonfunctional veins; they are inefficient in moving blood toward the heart and can pool blood within their lumen. Pooling blood within these veins can lead to blood clot formation and inflammation, thrombophlebitis that triggers severe local redness, and eve pain, skin irritation, and swelling. Moreover, the hemoglobin in the thrombosis will degrade into hemosiderin. The hemosiderin will leak out of these broken veins' walls, which are in close proximity of the skin and stain the skin, called hemosiderin staining or hyperpigmentation. In a vein treatment patient with light skin, this looks brownish color. Our immune system can initially help in clearing up the staining; however, with the hemosiderin's overwhelming flow, the skin will be permanently stained, brownish. This skin color is permanent and does not disappear over time. Other local changes to the adjacent skin are local inflammation, itching, scaling, or ulceration. It is important to note that skin ulcers can quickly expand.

Unlike simple skin cuts, venous stasis ulcers are tough to treat, sometimes taking months or years. The fluid leaking from these ulcers contains factors, which delay the healing process further. The venous stasis ulcers are excruciating and cause significant disability in many patients.

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