By Joseph Magnant, MD, FACS, RPVI and Jill Tanner, APRN
In today’s day and age with the internet at our fingertips, it has become easier for patients to play a more active role in researching their medical care. With just a few clicks, patients can now perform research on their health care providers’ training, experience, qualifications and even access patient reviews. This knowledge enables patients to choose the most appropriate specialist, with the best patient reviews, to evaluate their new or ongoing medical concerns.
Leg wounds, also known as leg ulcers, are a common cause for concern for many individuals. A leg ulcer is caused by a break in the skin that can range in size and is often slow to heal. Many times the ulcers occur as a result of a minor injury such as a scratch or a recent skin biopsy and in 90% of cases they are due to underlying venous insufficiency.
Venous insufficiency, also known as leaky vein valves, is caused when the one-way valves within our veins are not working properly. The veins in our legs carry blood back to the heart. When the valves are not working as they should, blood may leak back down into our legs and begin pooling. Over time, the high venous pressure can lead to leg swelling, discomfort, skin discoloration and in severe cases ulcers on the legs. Although there are different types of ulcers, venous ulcers are the most common.
Venous ulcers typically appear in the area just above the ankle on the inside surface of the calf, although they can occur in other areas as well. There is often a strong family history of venous insufficiency in patients with venous ulcers. There may be other signs and symptoms
of venous insufficiency in these patients such as varicose veins, heaviness, achiness, leg cramps, and restless legs. Signs and symptoms may occur in one or both legs.
Early investigation of venous insufficiency by a qualified vein specialist, which should include a detailed venous insufficiency ultrasound, will often disclose the culprit vein or veins with leaky valves. A variety of minimally invasive treatments, collectively referred to as endovenous ablations, are very effective and all share the common goal of sealing the leaking vein closed to stop the blood from pooling and reduce the venous pressure back to normal. Once this has been accomplished, ulcers often heal without much delay. In 15-20% of patients with venous ulcers, there may be a deeper pelvic vein problem where the outflow veins within the pelvis are compressed or pinched. There are new methods of making this diagnosis and minimally invasive techniques for opening these blocked pelvic veins using an advanced catheter based ultrasound placed inside the veins through a small IV. This technique is called intravascular ultrasound (IVUS).
Leg ulcers should be taken seriously and treated with a sense of urgency, as the mere presence of an open wound serves as an opening for bacteria to enter the blood stream which poses a risk of infection of artificial joint or pacemakers. Rather than just treating the wound with a variety of topical creams or ointments and repeated surgical debridement or hyperbaric oxygen therapy, it is critical to identify the root cause of the ulcer. Once the underlying disease is identified and treated appropriately, whether venous or arterial, the ulcers usually heal within 4-6 weeks. If you have a leg ulcer that has been slow to heal and you have not had a thorough evaluation to rule out venous or arterial problems, take the initiative to schedule an evaluation on your own. You deserve a thorough assessment to determine the underlying cause.
Vein Specialists has offices in Fort Myers and Bonita Springs and is the leading outpatient vein center in Southwest Florida. Vein Specialists is committed to excellence in vein care and is dedicated to increasing physician and public awareness of venous disease. For more information about vein disease and Vein Specialists, please visit WeKnowVeins.com or call 239.694.8346.
1500 Royal Palm Square Blvd., Suite 105, Fort Myers, Florida | 3359 Woods Edge Circle, Suite 102, Bonita Springs, Florida
WeKnowVeins.com | 239.694.8346
To illustrate the point, consider the story of a Vein Specialists patient, Penny N.
I have had vascular issues for a long time and have been seen by multiple vascular doctors.
When I moved to Southwest Florida, 3 separate individuals: a friend, a professional, and a physician recommended that I see
Dr. Magnant at Vein Specialists. How could I go wrong with such great references? So, I made an appointment.
Several years prior, I was bitten by a spider on my ankle while camping in Pennsylvania. I tried to self-treat, but it progressively got worse. By the time I saw the doctor it had become an ulcer and I was put in a special boot and placed on antibiotics. The ulcer would often open up when I would work out or swim. I ended up in an unna boot (a compression wrap) a few times, had vein surgery, and ended up having to have a skin graft. I continued to be very careful with my ankle and was always afraid to shave the area, since it was a sensitive spot and I was fearful of accidently causing another ulcer.
This brings me to my experience with Dr. Magnant and his practice Vein Specialists. After an initial consultation, I had a very detailed evaluation performed including leg vein and pelvic vein ultrasounds which revealed both leaky vein valves and a left pelvic pain
compression called May-Thurner Syndrome. I first had endovenous closure (heat sealing) of the leaky veins in my legs. Then I had a stent placed in my left pelvic vein to open up the flow out of my left leg. The final phase of my treatment involved foam sclerotherapy of the area around my ulcer. It’s been almost 2 years since I started with Dr. Magnant, but now I can actually shave my leg without worrying about injury and the skin has smoothed and softened almost back to normal. I can once again lead an active lifestyle.
I am so happy with Dr. Magnant and his staff for all they have done for me that I have referred other friends and colleagues to their
practice, Vein Specialists.