By Joseph G. Magnant, MD, FACS, RPVI
Modern air travel can be challenging for any number of reasons – long lines, cramped seats, and poor customer service to name a few. At Vein Specialists, many of our patients have difficulty with air travel for other reasons as well. They may have trouble sitting for prolonged periods due to the development of leg swelling and pain on flights of even a couple hours duration. I have had many patients report that their legs ache by the end of the flight or that they have trouble getting their shoes back on when it is time to exit the plane. These symptoms may often due to a common treatable medical condition known as venous insufficiency.
Venous insufficiency is a condition where the valves in the leg veins fail to close properly which results in pooling of blood in the legs which results in many of the signs and symptoms of venous disease. Blood pools in the leg veins, especially when standing or sitting for a prolonged period of time, as occurs when you are “trapped” in a cramped airline seat with your feet down. This leads to abnormally high pressure in the veins or venous hypertension. It is this venous hypertension which leads to the achy, heavy, swollen legs and feet people experience after a long flight.
Pooling or “stasis” of blood in the leg veins with prolonged sitting also can lead to potentially life threatening deep venous thrombosis or DVT. It is recommended that you get up and walk, do calf exercises and wear compression socks during travel to minimize this risk. DVT can be difficult to diagnose and may be asymptomatic in up to half of patients. If you have persistent swelling or leg pain after a long flight consider a vein evaluation to rule out DVT.
Venous insufficiency is a very common and underdiagnosed condition affecting millions of Americans. It is estimated to be present in as much as 40% of the adult population and becomes more prevalent after age progresses. As a rule of thumb, 1% per year of age, for example a 60 year old has a 60% chance of having venous insufficiency. Heredity is the major risk factor, although there are many other contributing factors such as advanced age, obesity, standing or sedentary occupations, female gender and prior pregnancies.
People are usually aware that varicose veins are caused by venous insufficiency, but often don’t realize that you can have venous disease without visible varicose. Leg swelling as well as achy, heavy or tired legs at the end of the day are frequently reported symptoms of venous insufficiency. The night time triad of restless legs, night time leg cramps and frequent urination is an often overlooked cluster of symptoms related to venous insufficiency. Severe cases of venous insufficiency may present as discoloration and
thickening of the skin around the ankles which is easily traumatized and may result in leg venous ulcerations.
Vein Specialists offers comprehensive, modern vein evaluation and care. We start by performing a complete history and physical examination and then offer detailed ultrasound evaluations in our office allowing us to formulate the best treatment plan for each patient.
The first part of every ultrasound performed in our office is to rule out the presence of DVT as the cause for the patient’s leg swelling or pain. When a DVT is discovered, the patient is seen by a provider before leaving our office and who can then coordinate anticoagulation therapy (blood thinner) with their primary care physician. If the study is negative for DVT, the registered vascular sonographer then proceeds to evaluate the entire venous system for insufficiency.
Modern vein evaluation and intervention is much different than it was years ago when invasive procedures such as vein stripping required general anesthesia, and had unacceptably high complication rates. In many cases the best and definitive treatment option for patients with venous insufficiency today is endovenous ablation. This is accomplished with either laser or radiofrequency catheters which heat and permanently seal the poorly functioning vein decreasing the venous pressure in the legs and significantly improving signs and symptoms of their. This procedure is minimally invasive and offered under local anesthesia in both our office locations with minimal discomfort.
The newest treatment option for vein closure is Venaseal™, which closes the vein using a medical adhesive rather than heat. This technique offers the advantage of requiring fewer injections and allowing us to treat the entire length of the vein from groin to ankle as there is no risk of heat induced nerve injury. Venaseal™ has been proven to be as effective as thermal ablation and is now covered by Medicare.
At Vein Specialists we offer comprehensive vein care and also perform removal of varicose veins through small incisions, called microphlebectomy, as well as injection sclerotherapy for bleeding or spider veins. Intravascular ultrasound (IVUS) for the investigation of patients’ pelvic or iliac veins is now available and may be appropriate for patients who have failed previous vein treatments, have had recurrence of symptoms, or have more advanced venous disease with severe edema, skin changes or ulceration.
Our team is led by Dr. Joseph Magnant, a board certified vascular surgeon, 3 advanced clinical providers, 6 registered vascular technologists, 8 medical assistants, 5 patient concierge representatives, and a half dozen support staff whose mission it is to make the financial part of the journey as smooth as possible. We are focused 100% on the management of venous disease, and our 2 office locations are the only IAC accredited vein centers in Southwest Florida.
If you or a loved one has achy, swollen legs after a flight, or if you have varicose veins or any of the other signs or symptoms of venous insufficiency, please consider visiting our website. Vein Specialists has offices in Fort Myers and Bonita Springs and is a 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