By Michael L. Metzger, M.D. –
Chronic Venous Insufficiency is a medical term that encompasses a huge spectrum of clinical conditions ranging from small blue or red spider veins that pose a cosmetic concern to many people, all the way to people with large painful, infected ulcers on the legs or ankle that may take months or years to heal. It is a very under diagnosed, and undertreated medical condition as an estimated 30 million Americans have Venous Insufficiency.
Regardless of the clinical issue for the individual patient, vein disease occurs due to a common pathologic problem, which will be reviewed here in addition to reviewing modern treatment options.
Often people come see me saying their doctor told them they have ‘bad circulation’. That is a non-specific term. The circulatory system of our body begins with the heart. The heart is a muscular pump that squeezes and pumps blood through the arteries to all reaches of the body – including the head, the inner organs, and to our extremities. The blood delivers oxygen to the targets, and the blood that is drained of its oxygen returns to the heart through the veins. So, a circulation disorder can be a problem of either the arteries or the veins (or at times both). The problems have different symptoms, different physical signs (what the Dr. sees when examining a patient), and different treatment options.
The veins of the body have soft valves within them to help assist in the transport of blood from the target organs or extremities back to the heart. In the legs, these valves have a huge task, as they need to close to prevent blood from leaking (or ‘refluxing’) down to the feet – which is what will happen due to gravity. If the valves become dysfunctional for any reason, then gravity will always win. When valves become dysfunctional for any reason, gravity will lead to excessive reflux and pooling of blood in the lower legs and feet.
After long periods of time on their feet (eg. School teachers, bankers, police officers), this pooling of blood in the feet and legs will accumulate and cause a pressure effect – this is called venous hypertension. This can begin with flat, soft, red or blue veins called spider veins that are a cosmetic concern to many people. Spider veins may itch or be mildly painful to some people. With time, venous hypertension will cause the veins to be distended and stretched out. This becomes the visibly bulging varicose veins people may have. Bulging varicose veins may also be tender and very painful particularly late in the day or after long periods of time on the feet. Finally, in advance stages, this swelling will damage the skin and can lead to a failure to heal simple wounds and ulcers will form that will not heal or close on the feet or lower legs.
After a careful medical exam, and probable specialized vein ultrasound, there are many effective treatment options for all stages of vein disease. For people with cosmetic concerns related to spider veins, sclerotherapy is the standard treatment. This entails careful injection of a chemical into the troubled area with a fine needle, along with careful tact and patience by the physician. This is very effective for large blue spider veins, and smaller ones too. There are however very small, often red colored spider veins which become unsightly to people. There is new technology called VeinGogh, using ohmic thermolysis to deliver radiofrequency energy to ablate spider veins. This is the first device of its kind with FDA approved for use on spider veins, and I have added it to my practice last year soon after its approval.
For symptomatic vein disease, there are simple conservative treatment options including frequent exercise like walking, keeping the leg elevated while sleeping or sitting, and wearing a compression stocking on the lower legs. This stocking keeps the veins under moderate external pressure, preventing the engorgement of these veins with blood that is the cause of the symptoms of venous insufficiency. This however, does not treat the underlying cause, but is very effective for symptom relief.
If conservative therapy fails (and symptoms persist), there are minimally invasive procedures that can be done with specialized IVs and catheters in the office as an outpatient. If the vein with the dysfunctional valves can be functionally eliminated, then the source of the venous hypertension and the associated symptoms will drastically improve. Historically, these problematic veins were surgically removed in a hospital setting with general anesthesia and surgical incisions and scars. Now with the use of specialized catheters, these veins can be ablated – or injured with radiofrequency or laser generated heat energy to cause the vein to shut down. The procedure is done safely in an office setting, and takes about 45 minutes, and the patient walks out of the office when completed and can be on their feet and even back at work or hobbies within a day.
While cosmetic spider vein treatments are most often not covered by insurance companies, the procedures for symptomatic vein disease is covered by most insurance plans, and we will work closely with you to be sure everything is understood and authorized prior to proceeding.
Dr. Metzger is a board certified Interventional Cardiologist with specialized training in Vascular Medicine and associated catheter procedures. To schedule a consultation, please call the office at 561-515-0080. Also visit our website at www.southpalmcardiovascular.com.