More than 30 million Americans suffer from varicose veins, or the more serious form of venous disease called chronic venous insufficiency (CVI), yet the majority remains undiagnosed and untreated.
Venous reflux disease, also known as chronic venous insufficiency, develops when the valves that keep blood flowing out of the legs and back to the heart become damaged or diseased. If venous reflux disease is left untreated, symptoms may worsen over time. As a result, vein valves will not close properly, leading to symptoms such as:
Once the valves in the leg stop working properly, they cannot be repaired. Treatment options available include closing or removing the damaged vein so that blood flow can be redirected to healthy veins. In the past surgical stripping was the only method available. Now there are several new non-surgical options available. Vora Vein & PAD Clinic is Owensboro area’s most experienced vein clinic and is at the forefront of non-surgical options and offer state-of-the-art methods to diagnose and treat the vein problems.
Deep Vein Thrombosis occurs when a blood clot develops in the large veins of the legs. A Deep vein thrombosis can be caused by anything that prevents our ability to circulate blood or for our blood to clot normally. Events that can affect our circulation and our ability to clot could be recent surgery, injury sedentary lifestyle, and medication.
Deep vein thrombosis can cause sudden swelling of one limb, pain, tenderness, change in color of affected extremity, as well as temperature. A deep vein thrombosis can also occur without any symptoms. If you develop signs or symptoms of deep vein thrombosis, contact you doctor. With Prompt diagnosis and treatment, DVT may not be life threatening.
Diagnostic studies used to identify DVTs could be: Ultrasound, Lab test, Venography, CT or MRI scans. After a diagnosis has been made a physician may take a couple of different approaches to treating a patient, depending on the size, location, and status of the patient. These treatments include blood thinners, clot busters, compression stockings, filters, and other surgical procedures. Treatment varies but the goal is the same, to keep the patient safe. Treatment is aimed at prevention, preventing the clot from growing and/or moving. After the clot is resolved, the focus goes to preventing thrombosis from happening again.
When a clot forms in a large deep leg vein, breaks free, and begins to travel through the vein it is then called an embolus. This can be very serious, an embolus has the potential to reach and become lodged in a lung artery. If an embolus becomes lodged in a lung artery it is considered a pulmonary embolism (PE) which is a potentially fatal condition.
Symptoms of a pulmonary embolus include chest pain, shortness of breath, rapid pulse, cough, anxiety, sweating, or fainting. If you were to experience any of these symptoms seeking immediate medical attention greatly reduces the risk of death. By taking steps towards preventing blood clots in your legs, we also protect ourselves against pulmonary embolism.
In order to diagnose a PE there are many different scans and tests, they include: Chest X-ray, Ultrasound, Blood tests, Spiral CT scan, Pulmonary Angiogram, and MRI.
Treatments include clot dissolvers which are called thrombolytics may be given through the vein to dissolve clots quickly in life threatening situations. For others, oral pills may be given which keep the clot from getting any bigger and lower the chances of another clot forming.
Post-thrombotic syndrome (PTS), sometimes called post-phlebitic syndrome is a long-term condition that occurs as a result of a deep vein thrombosis (DVT). More than one third of people who have DVT then develop PTS. It is most common for a DVT to occur in the legs but could occur in other deep veins as well.
When a thrombus (clot) stays in the vein for a long time or when DVT is not completely treated, the blockage can lead to increased venous hypertension. Inflammation associated with the process causes scarring of the vein walls and valves. Scarred veins do not expand as normal veins do, so when the flow of blood increases and they cannot expand, it causes a throbbing pain and swelling in the lower part of our legs.
The most usual symptoms of PTS are aching, swelling, cramps and pain in the leg, which is usually worse can after standing for long periods or walking and is typically relieved by resting or raising the leg
If you develop any of these symptoms, particularly if you know you’ve had a recent DVT, you should see your doctor as soon as possible.
PTS can be diagnosed by getting good medical history. Venous duplex and IVUS could be used based on the area affected.
PTS is a long term chronic condition and can affect your mobility, so it’s best to take preventative measures. The person should wear a compression stockings if you have had recent DVT. Sleeves (“gauntlets”) for post-thrombotic syndrome in the arm also exist and should be worn if there is arm swelling or pain. The other treatments may include leg elevation, pain medication, anticoagulant medication, angioplasty or stent depending on the extent of the problem.
Stasis Dermatitis is usually a precursor to more problematic conditions, such as venous leg ulceration. At first, symptoms seen are those affecting the ankles. There may be swelling that appears toward the end of the day and lessens after sleeping overnight. Eventually it leads to heavy or aching legs when standing for a prolonged period.
In the early stage, the skin may become red, swollen, which may later turn weeping and crusty. This can be made worse by bacterial superinfection or by contact dermatitis caused by the many topical treatments often applied.
When the red blood cells breakdown from the pooled blood, it leads to deep dermal deposit of hemosiderin (a protein from hemoglobin). This causes diffuse, red-brown discoloration. These spots can also be itchy. Sometimes, loss of hair may also accompany.
A number of diseases and conditions can increase your risk for developing stasis dermatitis but main factors are venous insufficiency, obesity, multiple pregnancy for females.
Diagnosis is usually based on good history and physical examination. Lower-extremity duplex ultrasound can be used to measure ankle-brachial index.
Treatment includes leg elevation, compression, and dressings. Sometimes topical or oral antibiotics may be recommended. Petroleum jelly or fragrance free creams can help reduce dry skin.
Stasis dermatitis tends to come back until the underlying cause (damaged veins) is addressed. Hence venous interventions like varicose vein closure or treatment for DVT –are needed to address the underlying cause.Primary prevention involves adequate anticoagulation after DVT and use of compression stockings for up to 2 years after DVT or lower extremity venous trauma. Lifestyle changes (eg, weight loss, regular exercise, reduction of dietary sodium) can decrease risk by decreasing lower extremity venous pressure.
This increased pressure subsequently affects the blood capillaries and more fluid is filtered from venous blood into the tissue. This extra fluid causes increased work for the lymphatic drainage system. The lymphatic system in spite of working to its full capacity, is not able to cope with the additional fluid which leads to edema in the lower leg.
During initial stages, the lymphatic system is able to 'catch up' with the excess fluid at night (when legs are rested and gravitational forces are inactive) so the venous pressure comes back to normal after the night rest. This is called phlebo-lympho-dynamic insufficiency (edema).
Diagnosis is usually based on good history and physical examination. Lower-extremity duplex ultrasound and ankle-brachial index are also useful.
The intervention at this stage would be leg elevation, compression, and exercise. But the main treatment focuses on treating the underlying problem.