Venous disease is generally caused by the improper flow of blood in the veins of the legs. When valves within veins malfunction or fail, blood is not pumped back toward the heart as it should be, and tends to pool in the lower legs. The blood pooling causes markedly increased pressure in the veins. This leads to a host of issues that can be both aesthetically displeasing as well as uncomfortable if not painful. Fortunately, modern treatments provide excellent outcomes that can rejuvenate the appearance of the legs as well as restore a higher quality of life to those who suffer from venous disorders.
One of the first signs of venous disease is the appearance of unattractive veins, visible through the surface of the skin. These veins may be flat or raised, small or large, and a variety of colors ranging from red to blue to purple. While veins are vital to the health and function of the human body, most would prefer not to have to see them visibly on the surface. And when unsightly veins are apparent beneath the skin, patients should consult their doctor for a full workup to determine their venous health. Fortunately, unsightly veins are highly treatable and the look, feel, and comfort of your legs can be greatly improved with modern treatment methods.
Types of unsightly veins include:
Varicose veins are enlarged veins that bulge like ropes beneath the surface of the skin, frequently dark blue or purple in color. Although varicose veins can occur anywhere on the body, they are most likely to appear on the legs. Varicose veins are very common, with around 40 million Americans affected by them.
Risk factors for developing varicose veins including having a family history of venous disorders, obesity, pregnancy, aging, gender (women are more likely to develop varicose veins), and working in an environment that requires you to stand on your feet or sit for long periods of time.
Varicose veins are superficial veins that have become abnormally dilated due to improper blood flow. When working properly, veins have valves that prevent blood from flowing backward. When these valves fail, blood pools and pressure builds with the veins, causing the veins to dilate and become more visible, as well as uncomfortable. Varicose veins can cause aching, itching, and throbbing, as well as burning and cramping.
Exercise, elevating your legs and wearing compression stockings to promote proper blood flow and reduce swelling can improve comfort levels. However, to prevent varicose veins from becoming worse and to improve comfort and appearance, patients will need to see a vein specialist such as Doctor Eston Wengerfor treatment.
Thanks to cutting-edge advancements in vein care, a vein specialist such as Doctor Eston Wenger can achieve excellent results in eliminating varicose veins with minimally-invasive procedures. Doctor Eston Wenger will perform an ultrasound to identify problem veins and determine the best course of treatment. Doctor Eston Wenger may recommend one or a combination of the following therapies:
- Endovenous laser ablation techniques
- Radiofrequency ablation techniques
A deep vein thrombosis (DVT) is a blood clot, also known as a thrombus, that has formed inside a deep vein, usually in a leg. The veins that are closest to the surface of the skin are called superficial veins. Deep veins are found in the deep compartments in the legs nearer to the muscles, especially those in the calf, thigh, and pelvis.
DVTs are fairly common, with as many as 2.5 million people in the U.S. alone affected each year. DVTs are also serious, because the clots have the potential to travel up the veins, through the heart and cause a blockage in the lungs. When this occurs, it is called a pulmonary embolism, and can be fatal.
DVTs can happen at any age, but are more common in adults over the age of 60. Doctors cannot always pinpoint the cause of each incidence of DVT, but there are several common risk factors that patients should be aware of to reduce their risk of experiencing a DVT. Anything that irritates the inner lining of a deep vein can cause a blood clot, including inflammation, autoimmune issues, and injuries.
DVTs can develop in the extremities after long periods of inactivity, such as after a long plane flight or if a patient is bedridden following a surgery or hospital stay. DVTs sometimes result following a surgical procedure. It is not uncommon to see patients develop a DVT following a cancer diagnosis, possibly because cancer incidence increases with age, and aging patients may be in poorer overall health and less physically active.
Blood clotting disorders like sickle cell disease are also responsible for causing DVTs, because they cause the blood to become thicker and stickier, increasing the risk of clot development. Additionally, patients on hormone replacement therapy or birth control pills need to be aware that their risk of developing a clot is higher. Smoking is also a risk factor for the development of DVT.
Most DVTs are completely asymptomatic. And although symptoms may not always be present with a DVT, there are some common signs to be aware of. You should seek medical attention immediately if you experience any of the following symptoms:
- Swelling of the leg.
- Pain or tenderness in the leg, which may increase when you put weight on the limb or walk. Pain may be severe.
- Leg feels warmer to the touch in the swollen area than in the surrounding tissue.
- Skin is discolored—typically red or purplish in tone.
Further, if you experience unexplained shortness of breath, chest pain when taking deep breaths, or cough up blood, seek immediate emergency assistance.
If your doctor suspects you might be experiencing a deep vein thrombosis, he will likely perform a duplex ultrasound to assess the blood flow and locate the clot. He may also recommend other radiographic technologies to confirm the diagnosis.
Once you have been diagnosed with DVT, you will be placed on an anticoagulant, or blood thinner. This is initially done with an injectable blood thinner such as enoxaparin (Lovenox) and then converted to a longer lasting blood thinner such as warfarin (Coumadin). There are numerous newer blood thinners such as dabigatran (Pradaxa), rivaroxaban (Xarelto), apixiban (Eliquis), and edoxaban (Savaysa). These medicines prevent the blood from clotting further so that the clot does not continue to grow. In some cases, a catheter may be used to deliver special drugs directly to the affected vein to dissolve the clot. Your doctor will monitor your case closely to ensure your health and safety.
Restless Leg Syndrome, or RLS, is a very common ailment in the United States, with around 5 million adults suffering from a moderate to severe form of the disorder. Patients with RLS experience intense, uncomfortable sensations in their legs, including burning, tingling, “tugging” sensations, itching, and a feeling of the skin crawling, among others.
RLS sensations are accompanied by an urge to move the legs to get relief from the sensations. Patients may find relief upon movement, but it lasts only as long as the movement does. The unpleasant sensations return as soon as movement ceases. The term “restless leg syndrome” comes from the constant need to move to find relief.
Symptoms generally set in after a period of inactivity, such as after working at a desk for a few hours, or once the patient has gone to bed. Patients are generally more troubled by symptoms at night, and the syndrome tends to worsen with age. While women are affected twice as often, men can develop RLS as well.
RLS sufferers may also experience Periodic Limb Movements of Sleep (PLMS), which is jerking and twitching of the legs due to involuntary movements while the patient is sleeping. This can disturb the rest of both the patient and their bed partner.
According to research, RLS may be caused by an imbalance of a chemical in the brain called dopamine, making RLS a neurological disorder. It may also be due to poor uptake of iron within the brain. If you have been diagnosed with RLS, you may find some degree of relief with massage, taking a warm bath before bed, stretching, exercise such as walking, and minimizing your intake of caffeinated beverages and alcohol. However, these are not long-term solutions.
RLS is categorized as either primary or secondary RLS. Currently the cause of primary RLS is unknown. There are numerous causes of secondary RLS. Chronic vein disease is one of the known secondary causes of RLS. Treatment of a patient’s underlying venous insufficiency frequently leads to improvement in their RLS symptoms.
Venous Reflux Disease is much more common than RLS, with an estimated 40% of women over the age of 40 suffering from the condition. Venous reflux disease is also responsible for the formation of varicose veins.
In cases of Venous Reflux Disease, vein valves become damaged or diseased, resulting in their failure. When valves fail it allows for backward flow of blood within the vein which is referred to as venous reflux. The backed-up blood pools, resulting in an increase of pressure within the veins. This may cause surface veins to dilate, leading to visible, bulging varicose veins.
The good news is that Venous Reflux disease can be effectively treated, thus improving RLS symptoms. A minimally-invasive endovenous ablation procedure will destroy the abnormal veins in under an hour, greatly improving appearance and eliminating symptoms. Patients can return to normal activities with only mild soreness and bruising, which can be treated with over -the-counter pain relievers. The success rate for this treatment is around 98%.
A common complaint from patients who suffer from chronic venous insufficiency is a red, itching rash. This rash, known as stasis dermatitis, is caused by the pooling of blood within the veins. Because the blood is not being moved properly through the veins, it builds up and causes increased pressure. The increased pressure leads to the leakage of a substance called fibrin, which is a fibrous protein necessary for the clotting of blood. When it seeps out into surrounding tissues instead of remaining within the veins, it causes inflammation and cell death, resulting in red, inflamed, and itching skin at the surface.
Patients may get some relief from stasis dermatitis by wearing compression stockings that promote proper blood flow and reduce pooling. However, to get the best results, the underlying venous insufficiency must be resolved.
Like varicose veins, spider veins are superficial dilated veins that are visible through the skin. However, spider veins are capillary veins, and as such, are much smaller and closer to the surface of the skin than varicose veins. Spider veins, also known as telangiectasias, are known for their delicate, web-like appearance under the skin. They are usually red to blue in color, and may occur around the nose and mouth as well as the legs.
Spider veins are considered to be a cosmetic issue as they generally do not produce symptoms like varicose veins do. However, your doctor may recommend that you undergo a venous ultrasound when considering treatment for spider veins in the legs, to ensure there aren’t further issues within your veins.
If you have spider veins that you would like to have eliminated, your doctor may recommend sclerotherapy, in which a liquid or foam is injected into the problem veins to cause them to close and collapse, eventually disappearing. Your doctor may also choose to use a laser treatment to target the veins, or a combination of laser and sclerotherapy treatments.
The term phlebitis refers to inflammation within the walls of a vein, and thrombophlebitis is a term that refers to inflammation that occurs at the surface of the skin due to an underlying blood clot in a vein. Unlike a deep vein thrombosis (DVT), which occurs in the deep veins of the legs, thrombophlebitis occurs in the superficial veins. Thus, while concerning, thrombophlebitis is not as dangerous as a DVT.
When a patient suffers from thrombophlebitis, their leg may become swollen, firm to the touch, discolored and tender. If the vein is not unblocked so that blood can circulate freely, tissue death may occur, followed by infection.
Thrombophlebitis can be caused by anything that can trigger a blood clot—for example, surgery, injury, sitting or standing in one position for too long, hormone therapy, genetic predisposition, or as a result of venous disorders such as varicose veins. If the blood flow is sluggish or is not moving correctly through the veins, it can pool in the leg veins, allowing clots to form.
If your doctor suspects that you have developed thrombophlebitis, he will perform a duplex ultrasound to identify the problem and locate the area of concern. Depending on the size and location of the clot, and your general medical condition, he may recommend a variety of treatment options including over the counter non-steroidal anti-inflammatory medications (NSAIDS), compression stockings and leg elevation for symptom relief.
Some patients may also be given blood thinners, but this is more common for clots that form in the deep veins. In some cases, microphlebectomy may be utilized to treat the underlying cause. Your doctor will make a personalized recommendation based on your unique needs to provide you with the safest and best results.