Venous Insufficiency
What is Venous Insufficiency?
A prior history of lower extremity DVT, or a familial tendency toward weakened superficial veins in the legs, can result in chronic leg swelling, skin changes including ulcerations near the ankle, or unsightly and painful varicose veins. Vascular surgeons deal extensively with such lower extremity vein problems. Patients who have chronically obstructed or incompetent deep veins can be managed with local skincare and elastic support stockings. Those with varicose veins also may have their symptoms relieved by elastic support stockings; when that does not help or is awkward or otherwise non-feasible, their symptoms may be significantly improved or even eradicated by various catheter techniques, carried out in the clinic, by which the incompetent superficial veins are eradicated by deliberately blocking them up with lasers or electrical current (“ablation”) or the injection of various materials (“sclerotherapy”).
Veins are blood vessels that carry blood from different parts of your body, back to your heart and lungs. Veins carry blood against gravity and have small valves within, which prevents blood from flowing back.
When valves in your veins do not close properly the blood starts to pool back in your legs which leads to dilated, tortuous veins, leg pain, swelling, discoloration, and itching. Depending on the severity and if left untreated it can lead to venous leg ulcers.
Varicose Veins
Varicose veins are dilated, tortuous subcutaneous veins measuring > 3mm in diameter. It is usually associated with superficial vein (veins closer to the skin surface) valve leak. It will require further evaluation with a venous ultrasound.
What causes varicose veins?
Some risk factors that can increase your chances of having varicose veins are:
- Family history of varicose veins
- Prolonged standing, sitting
- Obesity
- Inactivity / Sedentary lifestyle
- Advancing age
- Smoking
- High levels of estrogen (a hormone)
- Previous history of blood clots / trauma causing injury to veins
- Pregnancy / Postpartum period
- Hereditary conditions (conditions passed from parents to children) like Klippel – Trenaunay syndrome
Spider Veins
These are dilated intradermal and subdermal veins. They are very superficial and appear as bluish reddish small veins on the surface of the skin. They are usually less than 1 mm in diameter. These veins rarely cause any physical symptoms but may not be visually pleasing and is a cosmetic concern for many. It is more prominent in the legs. It can also indicate underlying vein valve problems which will require further evaluation with a venous ultrasound.
Common Symptoms:
- Symptoms may be absent
- Pain, swelling, itching, burning, leg heaviness, fatigue, discoloration of skin, prominent bulging veins, muscle cramps. Symptoms usually worsen by the end of the day and are often partially relieved with leg elevation and or use of compression socks.
- Bleeding - a minor trauma or injury can cause the vein to burst and bleed
- Skin Ulcerations - a severe form of venous disease
Diagnosis:
Usually through History and Physical exam. Also, using Venous ultrasound to detect lower extremity venous reflux duplex (LEV).
Treatments
Compression Socks:
The socks provide graded compression that compresses the vein and prevents blood from pooling down in the legs. The first non-invasive and conservative treatment tried for symptomatic varicose veins. A trial of at least 3 months is required before planning for any other treatments.
Ablation Therapy:
If compression socks are ineffective or only treat the symptoms partially ablation (mechanical, laser, radiofrequency) is an option. We use Endovenous laser ablation, Radiofrequency ablation, and Venaseal (chemical ablation) at SVS.
Micro Phlebectomy:
Mainly targeted at treating visible bulging varicose veins larger than 3 – 4 mm in size. Micro phlebectomy or Ambulatory phlebectomy uses a series of tiny incisions (stab incisions) between 1-3 mm in length to remove portions of the problem vein. The residual or remaining segments clot off as there is no continuous flow of blood in them.
Sclerotherapy:
Smaller tortuous varicose veins usually called spider veins (less than 1 mm in diameter) or reticular veins (1-3 mm in diameter) are treated by injecting a chemical agent called a vein vessel sclerosant which causes the vein to spasm and clot. The procedure causes minimal discomfort. It may take more than 1 treatment to see a significant improvement in the appearance of the treated spider veins.
Foam Sclerotherapy:
This involves the use of a vein vessel sclerosant which is injected in the target vein in the form of a foam than a liquid. The foam increases the surface contact of the medication with the vein wall than in its liquid form. Some larger prominent clusters of varicose veins and spider veins can be treated using foam sclerotherapy. The above treatments help lighten up the prominent varicose veins but over time new veins may develop at other places or around the previously treated spider veins and may require additional treatments.
Varicose veins are almost always associated with venous reflux. This occurs when the valves in the leg veins don’t work well, and backward blood flow causes pooling in the lower leg. Without treatment, the pressure this creates may increase over time and cause additional varicose veins and symptoms. People with a family history and who are older, obese or are pregnant may be at increased risk of developing varicose veins.
It is unclear if varicose veins can be prevented, but certain actions may help limit the disease’s progression and symptoms. Routine exercise, maintaining a normal weight, avoiding excessively long periods of standing or sitting, and the use of compression stockings may all help alleviate symptoms.
Sometimes the same factors that helped to cause your first spider veins or varicose veins (e.g., family history, age, obesity, female hormones, etc.) will make you predisposed to develop additional vein conditions. If a specific vein is properly treated, it usually does not recur, but it is possible that other veins may become diseased. This is why it is important that even if you have what appear to be simple, cosmetic spider veins, that you consult a vein specialist who can determine if you have an underlying condition (venous reflux). If you do, and you don’t treat the cause of the problem, additional spider veins or varicose veins are likely to develop.
There is a newer physician specialty called phlebology which focuses on vein treatment. This specialty has its own society (American College of Phlebology), provides board certification and specialty training. Consult with your individual physician to determine whether they have any such specialty training or certification.