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Varicose Veins & Venous Reflux

Abnormally dilated veins close to the skin surface can become externally visible.  Large veins (>3mm) that bulge through the skin surface are called “varicose veins”. Tiny veins (<1mm) visible at the skin surface are called spider veins.

Treatment of symptomatic varicose and spider veins typically starts by identifying and treating any underlying vein problems that may be causing increased pressure in the skin surface veins. The most common cause of increased pressure in the leg veins is a condition called venous reflux, where the valves in the leg veins have become dysfunctional.

Treatment of venous reflux typically involves office-based procedures that seal closed the bad vein(s), which eliminates back-pressure in the vein(s). Varicose and spider veins are typically treated shortly thereafter.

Symptoms
Diagnostic Workup
Treatment

Common symptoms of vein problems include leg heaviness, leg tiredness and leg aching. Leg cramping and leg restlessness are also commonly related to vein problems. Swelling in the lower part of the leg is extremely common. Sometimes vein problems will cause the legs to become itchy, a condition known as “stasis dermatitis“.

Leg symptoms secondary to vein problems are generally exacerbated by prolonged standing (or sitting), and are relieved by elevation of the leg(s).

In advanced cases the skin around the ankle may become discolored (typically brown or reddish skin discoloration). In severe cases skin wounds around the ankle can occur. Skin wounds around the ankle that are related to vein problems are called “venous ulcers”.

Patients with prominent varicose veins or symptoms suggestive of venous insufficiency merit evaluation by a vascular specialist.

A review of past medical and surgical conditions, current symptoms, medications, and physical examination are routinely performed. The decision about whether to perform adjunctive diagnostic testing is based upon the patients symptoms and exam findings.

The most commonly used test to evaluate the structure and function of the veins in the legs is “duplex ultrasound”. Duplex ultrasound is a painless study that involves using a hand-held ultrasound probe to shine high-frequency sound-waves through the skin, allowing visualization of the leg veins. The duplex study is able to visualize both the “superficial veins” and the “deep veins” in the legs. If present, abnormalities of valve function and venous blood clots are readily identifiable.

On an infrequent basis additional diagnostic tests such as venogram (injection of dye into the vein supplemented by X-ray imaging), or CT-scanning is required.

CLOSUREFAST™ PROCEDURE

VENESEAL™ PROCEDURE

Symptoms

Common symptoms of vein problems include leg heaviness, leg tiredness and leg aching. Leg cramping and leg restlessness are also commonly related to vein problems. Swelling in the lower part of the leg is extremely common. Sometimes vein problems will cause the legs to become itchy, a condition known as “stasis dermatitis“.

Leg symptoms secondary to vein problems are generally exacerbated by prolonged standing (or sitting), and are relieved by elevation of the leg(s).

In advanced cases the skin around the ankle may become discolored (typically brown or reddish skin discoloration). In severe cases skin wounds around the ankle can occur. Skin wounds around the ankle that are related to vein problems are called “venous ulcers”.

Diagnostic Workup

Patients with prominent varicose veins or symptoms suggestive of venous insufficiency merit evaluation by a vascular specialist.

A review of past medical and surgical conditions, current symptoms, medications, and physical examination are routinely performed. The decision about whether to perform adjunctive diagnostic testing is based upon the patients symptoms and exam findings.

The most commonly used test to evaluate the structure and function of the veins in the legs is “duplex ultrasound”. Duplex ultrasound is a painless study that involves using a hand-held ultrasound probe to shine high-frequency sound-waves through the skin, allowing visualization of the leg veins. The duplex study is able to visualize both the “superficial veins” and the “deep veins” in the legs. If present, abnormalities of valve function and venous blood clots are readily identifiable.

On an infrequent basis additional diagnostic tests such as venogram (injection of dye into the vein supplemented by X-ray imaging), or CT-scanning is required.

Treatment

CLOSUREFAST™ PROCEDURE

VENESEAL™ PROCEDURE

Spider Veins & Cosmetic Issues

Tiny veins (less than 1mm in diameter) visible on the skin surface are commonly called “spider veins”. The name “spider vein“ refers to the web-like appearance of these veins when clustered together. Most of the time spider veins are asymptomatic (or minimally symptomatic) and are primarily of cosmetic concern. To schedule your cosmetic consultation, click here.

Typically patients with spider veins can be reassured that their problem is not limb-threatening. Consideration can be given to cosmetic therapies such as injection sclerotherapy or transcutaneous laser.

Not infrequently, patients with spider veins will report localized symptoms of pain, itching, burning, or tenderness. Isolated (or scattered) spider veins typically represent a localized problem at the level of the skin. In this situation, underlying structural vein problems are unlikely, and it is not necessary to perform additional diagnostic testing.

In patients with extensive symptomatic spider veins (especially if larger varicose veins are also present), it is not unreasonable to perform duplex ultrasound testing on the leg(s) to evaluate for underlying structural vein problems that may be the nidus of the patient’s symptoms.

Symptoms
Diagnostic Workup
Treatment

Although most patients with spider veins report no significant symptoms, some patients with spider veins do report symptoms of tingling, burning or localized discomfort.

Spider veins are more likely to be symptomatic when multiple spider veins are present, when the spider veins are closely clustered, or problems are present in the larger underlying veins.

Most patients with isolated spider veins do not require extensive diagnostic testing.

In some situations (especially if the spider veins are combined with larger varicose veins or if significant symptoms are present) diagnostic ultrasound testing may be indicated.

At Vascular Solutions spider veins are treated with sclerotherapy or laser leg vein treatment.

Sclerotherapy involves injection of medicine into skin surface veins that causes the veins to contract and fade over time.

Sclerotherapy is commonly performed for cosmetic reasons, but sometimes sclerotherapy can be used to help alleviate symptoms of itching, burning and discomfort.

Sclerotherapy is ideally suited to veins measuring 1-3mm in diameter, but can also treat larger veins. Sclerotherapy can also treat tiny veins (measuring <1mm in diameter) but in this situation cosmetic laser treatment may be a better option.

Laser leg vein treatment is a purely cosmetic procedure that uses a hand-held laser device to eliminate small skin surface veins.

Laser leg vein treatment can be used to target any skin surface vein measuring less than 3mm diameter, but is ideal for tiny veins less than 1mm diameter. Cosmetic laser leg vein treatment is not indicated for the treatment of varicose veins, or any vein larger than 3mm in diameter.

Symptoms

Although most patients with spider veins report no significant symptoms, some patients with spider veins do report symptoms of tingling, burning or localized discomfort.

Spider veins are more likely to be symptomatic when multiple spider veins are present, when the spider veins are closely clustered, or problems are present in the larger underlying veins.

Diagnostic Workup

Most patients with isolated spider veins do not require extensive diagnostic testing.

In some situations (especially if the spider veins are combined with larger varicose veins or if significant symptoms are present) diagnostic ultrasound testing may be indicated.

Treatment

At Vascular Solutions spider veins are treated with sclerotherapy or laser leg vein treatment.

Sclerotherapy involves injection of medicine into skin surface veins that causes the veins to contract and fade over time.

Sclerotherapy is commonly performed for cosmetic reasons, but sometimes sclerotherapy can be used to help alleviate symptoms of itching, burning and discomfort.

Sclerotherapy is ideally suited to veins measuring 1-3mm in diameter, but can also treat larger veins. Sclerotherapy can also treat tiny veins (measuring <1mm in diameter) but in this situation cosmetic laser treatment may be a better option.

Laser leg vein treatment is a purely cosmetic procedure that uses a hand-held laser device to eliminate small skin surface veins.

Laser leg vein treatment can be used to target any skin surface vein measuring less than 3mm diameter, but is ideal for tiny veins less than 1mm diameter. Cosmetic laser leg vein treatment is not indicated for the treatment of varicose veins, or any vein larger than 3mm in diameter.

Deep Vein Thrombosis

Although there are deep veins in both the legs and the arms, blood clots more commonly occur in the legs.

Risk factors for deep vein thrombosis include prolonged immobility (such as long car rides or plane travel), traumatic injury (example; surgical intervention), and a variety of hematologic conditions that result in a propensity towards clot formation. Some of the hematologic conditions that increase the risk of blood clot are genetic in nature and can be evaluated with genetic testing.

Symptoms
Diagnostic Workup
Treatment

When a blood clot forms within a deep vein, the vein can become partially or completely “clogged”.   This obstruction to venous blood flow can result in increased pressure within tributary veins that are trying to flow into this pipe. In turn, this increased pressure within the more peripheral veins results in leakage of fluid from the veins into the tissues under the skin and can manifest as leg swelling.

Leg swelling is the most common symptoms of deep vein thrombosis. In addition to leg swelling, many patients report pain, aching discomfort, or tenderness in the area where the blood clot is formed. This pain and tenderness are likely related to inflammation in and around the vein wall as the body mounts a response to try and clear the blood clot.

Occasionally, blood clots(s) in the deep veins in the legs can fragment and travel to the heart and lungs. This condition is known as pulmonary embolism.   Common symptoms of pulmonary embolism include chest pain and shortness of breath.  Occasionally patients with pulmonary embolism will report that they have been coughing up small amounts of blood.

Only a small percentage of patients with deep vein thrombosis will sustain a pulmonary embolism. However, when the condition occurs it can be serious and life-threatening.

The most common diagnostic test used to confirm or exclude the presence of blood clot(s) is ultrasound testing. Modern ultrasound machines can not only detect the presence of blood clot within a vein but can also accurately evaluate the flow of blood through (and around) the area of the blood clot.

The management of blood clot in the deep veins is guided by a patient’s clinical presentation,  physical examination findings,  and ultrasound findings.

In the majority of cases, patients with fresh blood clots in the legs are treated by using blood thinner medications for a variable period of time.  The purpose of blood thinning medications is to prevent extension of the blood clot into adjacent veins, prevent additional blood clots from forming, and allow the body to start the healing process.

In cases of extensive fresh blood clot patients may be a candidate for procedures designed to more aggressively bust-up (dissolve) the blood clot.  The medical name for these procedures is pharmaco-mechanical thrombolysis (or venous thrombolysis). These procedures typically involve the temporary insertion of a thin piece of tubing into the vein that allows strong, clot-busting medication to be slowly trickled into the vein. There are several devices that can be used augment this clot-busting process.

Symptoms

When a blood clot forms within a deep vein, the vein can become partially or completely “clogged”.   This obstruction to venous blood flow can result in increased pressure within tributary veins that are trying to flow into this pipe. In turn, this increased pressure within the more peripheral veins results in leakage of fluid from the veins into the tissues under the skin and can manifest as leg swelling.

Leg swelling is the most common symptoms of deep vein thrombosis. In addition to leg swelling, many patients report pain, aching discomfort, or tenderness in the area where the blood clot is formed. This pain and tenderness are likely related to inflammation in and around the vein wall as the body mounts a response to try and clear the blood clot.

Occasionally, blood clots(s) in the deep veins in the legs can fragment and travel to the heart and lungs. This condition is known as pulmonary embolism.   Common symptoms of pulmonary embolism include chest pain and shortness of breath.  Occasionally patients with pulmonary embolism will report that they have been coughing up small amounts of blood.

Only a small percentage of patients with deep vein thrombosis will sustain a pulmonary embolism. However, when the condition occurs it can be serious and life-threatening.

Diagnostic Workup

The most common diagnostic test used to confirm or exclude the presence of blood clot(s) is ultrasound testing. Modern ultrasound machines can not only detect the presence of blood clot within a vein but can also accurately evaluate the flow of blood through (and around) the area of the blood clot.

Treatment

The management of blood clot in the deep veins is guided by a patient’s clinical presentation,  physical examination findings,  and ultrasound findings.

In the majority of cases, patients with fresh blood clots in the legs are treated by using blood thinner medications for a variable period of time.  The purpose of blood thinning medications is to prevent extension of the blood clot into adjacent veins, prevent additional blood clots from forming, and allow the body to start the healing process.

In cases of extensive fresh blood clot patients may be a candidate for procedures designed to more aggressively bust-up (dissolve) the blood clot.  The medical name for these procedures is pharmaco-mechanical thrombolysis (or venous thrombolysis). These procedures typically involve the temporary insertion of a thin piece of tubing into the vein that allows strong, clot-busting medication to be slowly trickled into the vein. There are several devices that can be used augment this clot-busting process.

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