Varicose Veins And Chronic Venous Insufficiency
Varicose vein symptoms include enlarged, twisted, rope-like veins that appear near the surface of the skin. While they can develop anywhere in the body, they are most commonly found in the legs and ankles because standing and walking increase pressure in the lower extremities. In normally functioning veins, tiny one-way valves open as blood flows toward the heart and close to prevent blood from flowing backward. When these valves malfunction, blood pools in the veins, resulting in a buildup of pressure that weakens their walls causing them to bulge. The way we treat most patients with varicose veins is with our endovenous laser treatment (EVLT). This state-of-the-art procedure allows us to effectively remove varicose veins without the traditional method of “vein stripping,” and no recovery time required.
Chronic Venous Insufficiency
Spider veins are ugly, small, red and purple veins that are easily visible through the skin. Although small, they have traditionally been very difficult to remove. There are a number of factors that can predispose one to getting spider veins.
Spider vein risk factors include:
- Jobs that require lots of standing, as seen among nurses, hair stylists, teachers, and others
- Hormonal influences during pregnancy, puberty, and menopause
- The use of birth control
- A prior history of blood clots
At Florida Vein Care Specialists, we use a combination of sclerotherapy and VeinGogh, a cutting-edge technology, that is proven to remove spider veins instantly and achieve the best possible results.
Spider veins being treated by VeinGogh's Ohmic Thermolysis System
Edema (Leg Swelling) can often be caused by venous disease as well. There are other conditions, such as congestive heart failure and lymphedema that can lead to chronic swelling of the legs. That is why it is important to get an ultrasound of the veins in your legs to determine if they are healthy and the blood is flowing up toward the heart and not refluxing and pooling in the lower legs.
Comprehensive overview of leg swelling by Chris Meyer MD
Venous stasis dermatitis symptoms include high pressure in the veins of the ankles, feet, or calves and may range from a fine red rash to large dark brown patches of skin. This is a sign of advanced venous disease. If left untreated it may progress to venous ulcers. At Florida Vein Care Specialists, we use a combination of ultrasound and a complete exam to relieve venous stasis dermatitis symptoms.
Venous skin ulcers are caused by poor blood circulation, as a result of venous insufficiency. Your veins have one-way valves that keep blood flowing toward the heart. In venous insufficiency, the valves are damaged, and blood backs up and pools in the veins. When this happens, it is possible that the blood may leak out of the vein and into the surrounding tissue. This can result in the breakdown of the tissue and an ulcer. Veins that become blocked also may cause blood to pool, leading to these ulcers. There are a number of things that can increase your risk of venous skin ulcers. These include:
- Deep vein thrombosis (when a blood clot forms in the deep veins of the legs)
- Lack of physical activity
- Work that requires many hours of standing
Venous ulcers often take up to 18 months to heal. They are painful and are a sign of the most advanced type of venous disease. Patients that undergo EVLT have a decreased likelihood of recurrent ulcers and the healing time of current ulcers is shortened.
Some chronic swelling of the extremities may be due to lymphedema, an obstruction of microscopic channels which pump and carry lymph fluid from the extremities back to the bloodstream in the chest. Lymphedema often presents as swelling at the toes or on the top (dorsum) of the foot though it may also involve the entire extremity.
Some patients are born with swelling in the extremities due to lymphedema and others develop lymphedema later in life. Abnormalities of the lymphatic channels present at birth result in congenital lymphedema; others will develop lymphedema due to obstruction from recurring cellulitis or soft tissue infections, surgical procedures, or compression by abdominal obesity or tumor growth. Lymphedema may be caused by internal production of tissue fluid such as by infection or high pressure in the veins due to venous insufficiency or venous obstruction. Morbidly obese patients with venous insufficiency usually have a component of lymphedema as well.
Mild lymphedema may be treated with elastic compression hose and periodic elevation of the legs higher than the heart. Evaluation and treatment of any underlying disorders is important as well. Severe lymphedema may require manual lymphatic drainage (MLD) therapy, a series of physical therapy treatments involving massage and compression wraps to reduce the degree of limb swelling.Some patients require daily use of compression pumps and sleeves on the involved limb to help pump the lymph fluid out of the limb. Untreated lymphedema usually will get worse and may even cause other complications.
Clot forming in the superficial veins of the skin or fatty tissues of the extremities is called superficial venous thrombosis (SVT). Symptoms often involve a tender lump under the skin at the location of a vein with a red discoloration of the skin overlying the thrombus. Superficial thrombus rarely is dangerous since it usually forms in peripheral veins. Although rare, it is possible for extension of the thrombus into the deep veins of the extremity (DVT) which is a much more serious condition. For this reason, venous color duplex ultrasound examinations frequently are employed to evaluate the extent of the thrombus.
The most common cause of SVT is varicose veins which are enlarged and result in slow blood flow through the varicose veins. Slowly moving blood is prone to clot within the varicose veins.
SVT in the lower extremities is treated with elastic compression hose and local comfort measures such as warm compresses. The pain associated with SVT usually improves considerably over a few days through local swelling and tenderness may last many months.
Anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen help with the symptoms of pain and tenderness and reduce the inflammatory process surrounding the vein.
The deep veins of the extremities are the veins within the muscles. Deep Venous Thrombosis (DVT), clotting in the deep veins is a serious condition which can lead to major disability or death if the thrombus migrates to the lungs and obstructs flow (pulmonary embolism).
A small thrombus (clot) in a small vein of the calf may be treated with close observation, oral aspirin therapy, elastic compression hose, and frequent walking or exercise in carefully selected cases with close ultrasound observation to be sure the thrombus is not propagating into larger veins. Other patients at higher risk for more extensive thrombus will be started on injectable and oral anticoagulant drugs immediately upon the diagnosis of DVT to prevent propagation of thrombus into the larger deep veins.
Thrombus in the larger deep veins such as the femoral veins of the thigh or the iliac veins of the pelvis usually will be treated with immediate anticoagulation with injectable anticoagulants, elastic support hose, and walking. Patients who have extensive new thrombus in the veins of the upper thigh or the pelvic/abdominal veins should be evaluated and considered for early clot removal. Currently, the best techniques for extensive early clot removal involve infusion of drugs into the thrombus through a small catheter which will dissolve the thrombus, often with the assistance of mechanical devices such as a rotating catheter or ultrasound waves directed into the clot. These pharmacomechanical techniques in carefully selected patients usually reduce the pain and swelling associated with extensive DVT, but they also considerably reduce the disability caused by post thrombotic syndrome (PTS) or development of venous ulceration months or years later.
Extensive DVT which is not treated with thrombolysis and which results in significant residual obstruction of deep veins in the thigh or pelvic (iliac) veins often causes PTS with chronic pain, swelling, tenderness, and venous stasis skin changes or ulcers at the ankle.
The most feared complication of DVT is pulmonary embolism (PE), migration of a clot to the veins of the lungs. PE can be lethal due to obstruction of blood flow through the lungs, but multiple episodes of small pulmonary embolisms may lead to gradual obstruction of the veins of the lungs leading to progressive shortness of breath and heart failure.
Some patients with DVT may require anticoagulant medications for a few months. Others require prolonged anticoagulation or lifelong anticoagulation. Because of the serious nature of DVT, it is important that if you develop acute swelling of an extremity to contact your doctor or a vein center immediately.