By Joseph G. Magnant, MD, FACS, RPVI – Vein Specialists of Fort Myers and Bonita Springs
We have all likely seen someone walking down the street and noticed large bulging varicose veins and thought “they should really see a doctor about that.” Varicose veins are the most obvious sign of venous disease, and represents a medical condition called venous insufficiency that encompasses a broad sector of the population. However, venous insufficiency can manifest as a variety of signs and symptoms other than varicose veins, many of which may not immediately come to mind when thinking about venous disease.
Venous insufficiency is a medical condition where the valves in the superficial venous system in the legs fail and, over time, lead to impaired blood return to the heart. Blood pools in the leg veins, especially when in the standing or sitting positions, leading to abnormally high pressure in the veins or venous hypertension, which results in the various signs and symptoms of venous insufficiency. These may include swollen achy legs, leg swelling, varicose veins, night time symptoms of restless legs syndrome (RLS), calf cramps and frequent urination. The most advanced signs are skin discoloration and thickening and possible venous bleeding or ulceration.
Venous insufficiency is a very common and often underdiagnosed condition affecting millions of Americans. It is estimated to be present in as much as 40% of the population and becomes more prevalent after age 50. Heredity is the major risk factor, as are a history of blood clots or DVT, obesity, standing or sedentary occupations, female gender, history of pregnancies, and advanced age.
Most people are aware of the most common sign of venous insufficiency which is varicose veins, but many people without varicose veins may also have venous insufficiency. Leg swelling, achy, heavy or tired legs at the end of the day are common symptoms. In severe cases, the skin around the ankles can become discolored, thickened or even ulcerated over time. As the pressure in the venous system builds throughout the day when patients are on their feet, symptoms progress and are usually worse in the evening and around bedtime. This is when the lesser known symptoms of venous insufficiency occur. We refer to them as the night time triad which include restless legs, leg cramps and excessive urination which can rob a patient of a good night’s sleep. All these symptoms can be caused by venous disease and many patients’ symptoms improve with treatment for venous insufficiency. A trial of compression hose can help predict which symptoms will most likely respond to venous treatment.
There are various signs and symptoms of venous insufficiency with which a patient may present, prompting visits to various medical specialties. Examples may include:
A. Dermatology for a biopsy of discolored skin round the ankle, “itchy” skin that does not respond to topical medications or a nonhealing biopsy site.
B. Cardiology for lower extremity swelling or fluid overload
C. Urology for bladder issues like frequent nighttime urination.
D. Neurology for neuropathy, leg cramps or restless legs syndrome.
E. Wound Care for what appears to be “diabetic ulcers” or other non-healing leg ulcers.
F. Orthopedics for ongoing inflammation or swelling after a successful total knee replacement.
G. Gynecology due to unexplained pelvic pain, painful menstruation, or pelvic pain during or after intercourse.
A newly recognized venous problem is Pelvic Congestion Syndrome (PCS}, which primarily affects women. Often, treatment for PCS is delayed, as many patients do not realize that symptoms such as pelvic pain, pain with intercourse, or pain with menstruation are related to a vascular disorder rather than gynecological one. PCS occurs due to iliac vein compression, where the iliac veins become narrowed or blocked by the overlying artery, resulting in pelvic varicose veins that put pressure on the surrounding pelvic organs. Patients who present with PCS often experience persistent achiness or pain in the buttocks, thigh, or knee regions with prolonged sitting or standing which often leads them to seek treatment from an orthopedist, pain management specialist, or chiropractor.
We understand that at times it may be difficult to determine which medical professional to initially see for your symptoms, however, with our ongoing venous disease education within the community, our goal is to promote earlier detection of venous insufficiency. Dr. Magnant offers monthly seminars where patients can learn more about venous disease and the various treatment options offered.
Modern vein evaluation and treatments are much different than they were years ago. Prior to 2000, procedures such as vein ligation or stripping were the only treatments available and were very invasive, required general anesthesia, and had unacceptably high complication rates. For this reason, most patients with venous insufficiency were forced to suffer as there were no acceptable and effective treatment options available.
At Vein Specialists in Fort Myers and Bonita Springs, we offer comprehensive, modern vein evaluation and care. Dr. Magnant is a Board Certified Vascular Surgeon focused 100% on the evaluation and minimally invasive management of venous disease. My team of Advanced Providers and I will start by taking a detailed history and
performing a detailed vascular system focused physical exam and then offer detailed ultrasound evaluations in our office which is the gold standard in evaluating venous disease.
We are then able to formulate the best treatment plan for each individual patient. In many cases the best treatment option for patients with venous insufficiency is something called endovenous ablation or vein closure. This can be accomplished with either heat (Radiofrequency or Laser) or medical adhesive (Venaseal) which allow us to permanently seal the poorly functioning veins decreasing the venous pressure in the legs and significantly improving vein related signs and symptoms. These procedures are minimally invasive and offered under local anesthesia in both of our office locations with minimal discomfort and immediate return to normal activity. Other treatment options such as removal of varicose veins through small incisions (microphlebectomy) or foam/liquid sclerosant injections of small varicose veins or spider veins (sclerotherapy) are also offered.
If you or a loved one has varicose veins or any of the other signs or symptoms of venous insufficiency such as leg swelling, fatigue, achiness, cramps or restless legs please call 239-694-8346 to schedule an appointment or visit our website at
www.WeKnowVeins.com for more information.