What is “chronic venous insufficiency?"
Veins are blood vessels that return oxygen-poor blood to the heart. Normal leg veins have one-way valves in them which help maintain blood flow against the force of gravity. The valves can become non-functional for a variety of reasons, to include genetics, hormonal changes, pregnancy, prolonged standing, and a history of blood clots. When the valves are not working correctly, gravity acts on the blood in the venous system, causing the veins to become swollen. Veins closer to the skin may seem to "pop out" of the leg and are visible as twisting, bluish cords, known as varicose veins. The underlying valve problem can also contribute to symptoms of leg tiredness, aching, pain, and swelling after standing for long periods. Untreated valve problems can progress to skin breakdown and the formation of an ulcer, or sore, located close to the ankle.
Are certain groups of people predisposed to having problems with their veins?
Yes. People of all ages, from their 20‘s to their 80‘s, can have problems, and men and women alike can have venous disease. But, having what I call “the bad vein gene” is a big risk factor. This disease process tends to run in families. If your parents or siblings have bad veins, chances are, you will too. We are also seeing that this disease process is associated with hormonal changes. Women tend to have more problems with their veins than men. Due to hormonal changes in pregnancy, pregnant women are especially susceptible to developing varicose veins and vein problems. Also, patients who have a history of blood clots in their leg veins are more likely to have damaged valves, and are consequently more likely to have problems with chronic venous insufficiency.
How does someone know if they have “bad veins?"
Well, they usually have symptoms of the veins “backing up” and becoming swollen with blood. Patients typically will note that their legs are tired, achy, painful, or swollen, especially after they stand for a long period of time. Also, they will usually see blue, puffy veins popping out of their legs.
And why is it important to get this problem checked out?
This is a chronic disease process. It usually gets worse as time goes on. Patients who have chronic venous insufficiency are more likely than folks who don’t have this problem to have worsening symptoms later in life or end up with blood clots in their leg veins. The clots form because the blood doesn’t more as efficiently up to the heart. It just stagnates and hangs out in the leg. Not only can the blood then clot, but all of this added pressure in the leg can end up breaking your skin down and causing an open sore on your leg by the ankle, something called a venous stasis ulcer.
So, what should I do if I think I have a vein problem?
You should come see me! At the office, we offer free vein screenings, during which we would chat about your symptoms and I would perform a limited physical exam of your legs. If it looks like you have a vein problem, we would then set you up for a full consultation, which usually includes an ultrasound.
What does a vascular ultrasound involve?
An ultrasound to look for venous insufficiency is a painless exam done in my office. It involves putting some warm ultrasound jelly on your leg and looking at your leg veins with an ultrasound probe, which is placed on your skin. I have an RPVI credential, which stands for “Registered Physician in Vascular Interpretation,” which enables me to perform and interpret the ultrasound myself. I find that performing the study myself is very meaningful in understanding each patient’s individual vein anatomy and pathology.
What does treatment for venous disease involve?
That’s the great part! The treatment is accomplished with minimally invasive techniques, right in the office setting. There’s no need to have a big operation in the hospital. Back in the old days, vascular surgeons used to fix this problem with an operation called “vein stripping.” That surgical procedure involved making at least two incisions on the leg, passing a stripping device into the vein, pulling the vein out of the leg, and then sewing up the incisions. Patients oftentimes had a lot of bruising and pain after the operation, and it took them awhile to recover and get back to normal activities. Nowadays, there are minimally invasive options available which can be performed under local anesthesia in the office with no need for stitches!
How long does the procedure take and when can I go back to normal activities?
Usually, the procedure takes less than an hour, and most patients go back to normal activities in 1-2 days. I would recommend waiting a week before engaging in strenuous activities, though.
But, what if I don’t have any problems with varicose veins; what if I just have those ugly little spider veins? Can you treat those?
Sure, but it’s really important to make sure that you don’t have underlying venous disease before treating spider veins. Otherwise, you can treat the spider veins, and they’ll just come back in other places. Treatment of spider veins involves injecting the veins feeding them with an irritant solution and a tiny little needle. That solution causes the vein to not have any more blood in it. As the vein atrophies, you won’t see it anymore. It’s really rewarding to watch this process; I think it’s almost magical. I also have a vascular laser, which can help to eliminate spider veins. Treatment of spider veins can involve a combination of laser treatments and sclerotherapy with the irritant solution.
Since you were talking about the importance of recognizing venous disease as a medical problem, are these treatments covered by medical insurance?
The consultation and the minimally invasive treatments for venous insufficiency and varicose veins are usually covered by medical insurance, and my office accepts most medical insurances. Unfortunately, insurance companies usually do not cover the treatment of spider veins.