By Dr. Stephanie Saltzberg and Dr. Adriana Laser
Venous disease, such as varicose veins, is much more common than you may think. It affects over one-quarter of the U.S. population. Vein problems are not just cosmetic but can be associated with significant symptoms. They can sometimes even cause debilitating, chronic wounds as well as other complications.
Women are not the only ones with varicose veins. This problem affects men as well. Risk factors include genetic predisposition, obesity, pregnancy/hormonal fluctuations, advancing age, female gender, trauma, DVT (blood clots), and occupations with prolonged sitting or standing such as hairdressers, nurses, teachers, correction officers, and construction workers. In addition, there are rare conditions that are present at birth that can lead to significant venous disorders.
The venous system is responsible for returning blood to the heart after it has delivered oxygen and nutrients to the organs and muscles. Veins have tiny one-way valves to keep blood flowing towards the heart against gravity. Muscle contractions in the leg help “push” blood in the venous system upwards to the heart in the central venous circulation. If these valves become damaged (incompetent) then blood pools inappropriately within the veins of the legs. This process is called reflux and causes the veins to become engorged with blood, which can lead to fluid seepage into surrounding tissues. Alternatively, the problem can be higher in the pelvis, with larger central veins being narrowed (stenosis), decreasing flow and drainage. These can result in swelling (edema), varicose veins, bleeding, discolored thickened fragile skin (dermatitis), and even open wounds (ulcers).
Patients who seek medical advice have conditions ranging from spider veins to venous ulcerations.
• Spider veins: These tiny red or bluish purple veins are located in the superficial layers of the skin and subcutaneous tissues. They tend to be cosmetic in nature.
• Varicose veins: These are abnormally enlarged bulging veins found in the subcutaneous tissue. Symptoms can include burning, itching, swelling and throbbing in the area of the engorged veins particularly at the end of the day. Sometimes blood within the varicosities can clot leading to a painful condition called phlebitis. As well, varicosities can sometimes bleed when overlying skin is bumped or shaved.
• Stasis dermatitis and venous ulcers: Patients with prolonged venous insufficiency can develop skin color and integrity changes usually in the calf or ankle region. In the most severe situations, ulcers can form which can be painful, difficult to treat, and debilitating to the patient.
The diagnosis of venous disease is made by a combination of patient history, family history, physical examination, and imaging studies. Ultrasound is routinely used to study the blood flow within the deep and superficial venous systems of the legs. Venous ultrasound includes evaluating the deep veins for venous thrombosis (DVT) and assessing the superficial, deep, and perforator veins for venous valvular competence. Conventional venography, contrast dye injection into the veins under continuous x-ray, may also be utilized particularly for deep venous issues in the pelvis. Occasionally additional imaging studies such as CT scan or MRI of the venous system may be required.
The fundamental principle in the treatment of venous disease is the reduction of pressure. This is accomplished by elevation and compression, the primary therapies for venous insufficiency. Compression can be obtained through the use of graded compression stockings or with the use of compression wraps which can be placed under the care of a physician. Leg elevation and weight control are also key components of the management.
There are also minimally invasive interventions to address varicose veins, spider veins, blood clots, and deep venous insufficiency. These procedures are often performed in the office or an outpatient setting with little to no downtime, few complications, and fast recovery to ensure patients are quickly back to their activities and busy lives.
• Spider veins: Injection sclerotherapy can be utilized. This treatment involves injecting an FDA approved solution into the veins causing them to scar down.
• Varicose veins: Ambulatory micro-phlebectomy can also be performed in the office alone or as an adjunct to venous ablation to remove the bulging superficial varicosities with few complications and minimal postoperative discomfort
• Venous insufficiency (saphenous vein reflux): For those patients with superficial vein reflux, treatment can include removing or closing the veins. Technological advances now allow us to treat these varicose veins minimally invasively with venous ablation rather than “old-fashioned” vein “stripping.” Venous ablation is performed in the office using either laser energy or radiofrequency.
• Central venous issues: Contrast venography with intravenous ultrasound, balloons, and stents, are also utilized in the minimally invasive diagnosis and treatment of deep venous insufficiency and narrowing (stenosis).
• DVT (blood clot): Clot-busting medications known as thrombolytics can be administered for some deep venous thromboses (clots). Although varicose veins are not completely preventable, compliance with compression, leg elevation, exercise, and weight control can improve venous circulation.
The Vascular Institute for Health and Disease is dedicated to the diagnosis and treatment of venous disease. We offer the most current modalities available for comprehensive care of our venous patients in the communities in which they live. Please call us with any questions or for a consultation (518)262-5640.