By Joseph Magnant, MD, FACS –
There are many different presentations of leg vein problems although the most recognizable is that of varicose veins. Other signs and symptoms of venous reflux disease (also known as venous insufficiency, CVI, venous incompetence or leaky veins) include swollen, achy legs, restless legs, night time leg cramps and urination, diffuse spider veins, skin discoloration in the lower legs, and bleeding or ulcerations in the legs. Venous insufficiency is defined as failure of the valves in the veins to close tightly resulting in the backward flow of blood back down toward the feet. The end result is increased pressure in the veins in the lower legs and feet which causes veins just under the skin to bulge (varicose veins) and water and protein to leak out into the surrounding tissues of the legs.
Over the past decade, our anatomic and physiologic understanding of venous insufficiency has been greatly improved as endovenous ablation (sealing of the veins) has been applied to patients with more obscure signs and advanced stages of venous insufficiency with excellent results. Superficial veins other than the great saphenous vein, such as the small saphenous vein, intersaphenous vein, anterior accessory saphenous vein and perforating veins are now treatable with endovenous ablation. Modern ultrasound evaluation of the lower extremity venous system by experienced vascular technologists can accurately identify which veins are insufficient or leaking as well as the severity of reflux.
Ultrasound directed sealing of the abnormal veins under local anesthesia has yielded far superior results than vein ligation or stripping, which are no longer required nor should ever be considered. With the introduction of minimally invasive treatments for venous insufficiency (leaky veins) in 2000, and the increased acceptance and application of this technology of sealing rather than stripping of the saphenous veins in the treatment of the entire spectrum of symptoms related to venous insufficiency, there is no need for patients to suffer from their venous disease any longer, whether bulging varicose veins, swollen achy legs or advanced skin changes.
The age old recommendation of waiting for varicose veins to “bother you” or “become painful” should be abandoned, and proactive evaluation and earlier treatment of the underlying venous disorder considered to prevent potential complications of bleeding and thrombosis (clotting) of the varicose veins which may extend to the deep system of veins and in rare cases lead to blood clots traveling to the lungs (pulmonary embolism). Patients are not advised to wait for complications of high blood pressure, high cholesterol or diabetes before initiating therapy, nor should they wait for complications of venous disease before considering minimally invasive evaluation and treatments.
Complications of Untreated
Clotting, as seen in the photo above of a 55 year old male who was told to leave his varicose veins alone. They clotted off on a long car ride and by the time he was seen by a physician he had a deep vein thrombosis requiring more than 6 moths of blood thinners. He eventually underwent endovenous closure of the culprit vein with an excellent result as seen in the photo on the right, but could have been saved the trouble and pain if he had been evaluated and treated earlier, before the complication occurred.
Patients likely to have venous insufficiency are those who have a family history of varicose veins, swollen legs or other obvious signs of vein disease. Other risk factors for developing venous insufficiency are history of pregnancy, obesity, sedentary occupations, advanced age, female gender and history of deep vein thrombosis. Patients may have varicose veins or other signs such as skin changes of color and character, brown, brawny and thickened skin, diffuse spider veins in the distal leg and ankle regions, open or threatened ulcerations, history of bleeding from veins in the lower legs, diffuse swelling in the legs worse at the end of the day and improved with elevation.
The following are the top 7 reasons patients should get moving this fall and get their leg vein problems treated.
1. The weather has finally cooled off and compression hose are at least tolerable after their vein treatments.
2. The snow birds have not taken over the roads and doctors’ waiting rooms…yet.
3. You vowed that last summer was the LAST summer you were going to wear long pants to the beach to cover your unsightly legs.
4. You want to get your legs ready for that Christmas or New Years cruise (gotta plan ahead!)
5. You have met your deductible for 2013 and have been meaning to make your legs more of a treatment priority.
6. You are uncertain regarding the future of healthcare and what conditions may or may not be covered for which diagnoses or symptoms.
7. You understand that varicose veins can clot or bleed and want to prevent these complications from occurring.
Endovenous ablation or sealing of the leaking veins with catheters (laser or radiofrequency) placed temporarily inside the veins offers a very safe, effective and minimally invasive option for patients once thought to be untreatable for Venous Insufficiency due to age, illness, lack of “illness”, absence of ulceration or bleeding. Ultrasound evaluation for venous insufficiency is safe, effective, risk free and offers a tremendous amount of physiologic and anatomic information which is critical in the decision making process. Vein specialists are seeing record numbers of patients with the diagnosis of venous insufficiency, many of whom have obvious signs of venous disease such as leg swelling, skin changes, varicose veins or ulcerations as well as others who may not have very impressive external findings of venous pathology but who have severe venous reflux disease as the root cause of their symptoms. Since venous disease affects one out of five adults in the USA, it makes perfect sense to consider venous disease early in the course of your search of the cause of your leg symptoms and if you have obvious varicose veins, you can be sure you have a problem with the valves in the veins and we encourage you to be proactive in obtaining venous evaluation.
Leaders in Vein Treatment
The modern evaluation and treatment of venous insufficiency is the singular focus of Dr. Magnant and his professional and compassionate staff at Vein Specialists at Royal Palm Square in Fort Myers, FL. He can be contacted either by calling 239-694-8346 or through his website, www.weknowveins.com, where patients can submit their request for an appointment. He encourages readers to review his website which is specifically written for his patients and also take the time to view his photo gallery. Venous disease is not a laughing matter, but sometimes it is only through humor that some of us are motivated to act.