What is Chronic Venous Insufficiency?
With CVI, the veins of the legs are unable to return blood properly from the legs to the heart. Normally, the valves in the veins maintain blood flow in one direction. In CVI, these valves malfunction, allowing backward flow (venous reflux), leading to the pooling of blood and water in the legs, causing dilated veins known as varicose veins.
What are varicose veins?
Varicose veins (or spider veins) are engorged, twisted veins that one can see just under the skin.
There are two primary types of vein conditions—both indicate some level of underlying venous insufficiency. Spider veins are tangled groups of tiny blood vessels just under the skin’s surface. Typically, they are red, blue or purple and are clearly visible on the thighs, lower legs and face. Varicose veins tend to be larger in diameter and are visibly bulging or rope-like.
What are the symptoms of varicose veins?
Both types of vein conditions can produce physical symptoms which can include:
- Leg pain
- Throbbing, aching or cramping
- Fatigued or heavy-feeling legs
- Itching or burning
- Swollen lower legs or ankles
- Restless legs
- Venous ulcers
Who is at risk of developing CVI?
It is estimated that 40 percent of people in the United States suffer from some form of CVI. More than 30 million Americans are symptomatic.
Venous insufficiency can be the result of heredity, age, gender (women affected more than men), obesity, history of deep vein thrombosis (blood clots), pregnancy, inactivity, or occupations that require prolonged sitting or standing.
When should you seek treatment?
See a vein specialist if:
- your veins are warm to the touch and tender
- your veins cause pain
- you are developing sores, rashes, or ulcers on your skin
- skin on your ankle or calf is changing color and thickening
- your veins bleed
How are varicose veins diagnosed?
A detailed history and physical exam of the legs are performed. Often, a duplex ultrasound, a type of non-invasive vascular ultrasound, is performed to assess the degree of venous insufficiency and determine the location and extent of incompetence. Further tests may be indicated if there are signs of a deep vein problem.
What are the treatment options?
- Healthy diet and weight loss. Weight loss can positively impact overall health but losing excess weight can also significantly lessen the pressure on legs veins, resulting in improved blood flow.
- Alternating between standing or sitting improves circulation
Compression stockings improve the signs and symptoms of various conditions of venous disease by providing graduated compression therapy to help control leg swelling and discomfort. They are designed to provide support to the legs and veins, assist with circulation, and minimize swelling.
Radiofrequency ablation (RFA)
RFA is a minimally invasive varicose vein treatment that uses radiofrequency energy (electricity) to heat, collapse and seal off the targeted blood vessels. Blood flow is automatically rerouted through healthier adjacent veins, restoring healthy circulation and reducing swelling. The ablated vein scars down and is absorbed by the body. The procedure is performed under local anesthesia or optional sedation by Dr Rami at our ambulatory surgical center. Patients are encouraged to walk immediately following the procedure, and are usually able to resume normal activities within a day. The use of compression stockings is generally prescribed for a week or two.
Sclerotherapy consists of one or a series of simple injections of medication known as a sclerosant. It is commonly reserved to treat spider veins and even larger varicose veins or tributary branches. Using a very fine needle, the solution is carefully injected into the vein under direct visualization or with the aid of a special vein illuminating light. The solution damages the inner lining of the vein causing it to scar and close down. After traveling a short distance, the sclerosant is diluted and neutralized, causing no further effects. Over a short period the vein closes, shrinks and eventually disappears. Polidocanol is a medication which has foaming properties and a foamed sclerosant is more powerful, allowing treatment of larger veins with lower concentrations. Ultra-sound guided foam sclerotherapy injects sclerosant using direct visualization of the vein with ultrasound.
For some larger varicose veins resilient to ablation or sclerotherapy, ambulatory phlebectomy may be recommended. This minimally-invasive procedure involves micro-incisions along the length of the affected vein. A tiny tool is then used to remove the vein in small sections. Incisions are closed with sterile strips, eliminating the need for stitches or any scarring afterward.