I thought this was an interesting article. It can be found at http://heartlung.osu.edu/article.cfm?ID=1920
COLUMBUS – When blood clots form in veins close to the skin surface in the legs, the presence of varicose veins can actually be a good sign despite their typically unattractive appearance, doctors say.
Any blood clots in the legs should be examined by a physician, but if they accompany varicose veins, that’s a strong indication that valves in the veins are malfunctioning rather than suggesting the presence of a much more dangerous clotting disorder, said Dr. Bhagwan Satiani, a vascular surgeon at the Richard M. Ross Heart Hospital at The Ohio State University.

In a recent observational study of patients with superficial venous thrombosis, or surface blood clots, in their legs, about 80 percent of patients had varicose veins. Among these patients, more serious deep-vein clots were uncommon. However, in the 20 percent of patients who had no varicose veins, the incidence of deep vein clots was 33 percent, Satiani said.

The study results were published in a recent issue of the journal Vascular Medicine.

Clots in the deeper veins of the leg can be important indicators of a clotting disorder that requires treatment beyond a vascular repair. Clotting disorders can be dangerous because of the elevated risk of a blood clot traveling to or lodging in blood vessels in the lungs. Such disorders, and any deep vein clots associated with them, are typically treated with blood-thinning agents delivered through injections or in pills.

“Most superficial clots are not associated with deep vein clots, which means the surface clots are not going to move,” Satiani said. “They’re not as scary as people may think.”

Symptoms of surface blood clots in the legs include isolated redness, pain and swelling that indicate the body is reacting to the clot, Satiani said. Most patients with surface blood clots can be safely treated with applications of heat, compression stockings or elastic bandages, nonsteroidal anti-inflammatory drugs, frequent walking and elevation of the affected leg. Many such clotting problems are resolved within two to three weeks.

Even when varicose veins are a good indicator that a surface blood clot in the leg is unlikely to move or involve deeper veins, physicians routinely perform an ultrasound scan to rule out involvement of deeper veins and to monitor the status of the clot, Satiani said.

Satiani described varicose veins themselves as a mechanical problem. “Within the veins, the valves that act as gates don’t work properly, and blood heading upward toward the heart reverses direction,” he said. “Most clots in varicose veins are not dangerous as long as they are not close to the junction of the leg and the abdomen. There’s a cause for concern when these clots seem to move upward, because those may involve the femoral vein, the main vein in the leg.”

However, larger varicose veins even without clots can cause aching, swelling and fatigue of the lower legs and may require treatment to close off or remove the vein. The malfunctioning valves cannot be repaired, so physicians use heat, injected agents or surgery to close or remove the veins with the most severe mechanical problems, Satiani said.

Between 80 percent and 90 percent of varicose vein cases are inherited, so there is little people can do to prevent the problem, he said. Pregnancy or injury to the deep vein system also can cause varicose veins to form.

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