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Cardiovascular Institute

Venous Disorders

Understanding Venous Disorders

Abnormal function of the lower extremity veins can lead to venous insufficiency, a condition that can cause varicose veins, leg swelling, and wounds of the legs that are persistent. Abnormalities of the lymphatic vessels can also cause leg swelling and wounds that are difficult to manage.

Venous Insufficiency

This is the general term that refers to abnormal function of the veins. Most commonly, venous insufficiency affects the legs but rarely can involve the arms. Whereas the arteries carry blood from the heart, through the legs, and on to the feet, the veins return the blood back to the heart. The heart serves as the pump for the arterial blood, but the calf muscles provide the force that returns the venous blood back to the heart. The presence of one- way valves in the veins is crucial to the function of this system. When the vein valves fail, blood can travel in the reverse direction and increase the pressure in the veins. This condition is known as venous insufficiency and can lead to leg swelling, open wounds, and varicose veins.

Varicose Veins

The venous system of the legs is divided into three components: deep veins, superficial veins, and communicating veins that connect the deep and superficial. Varicose veins are dilated superficial veins that result from venous insufficiency in the superficial system. Patients may be born with or develop abnormal valve function in the superficial veins that leads to elevated venous pressure. The involved veins expand under the increased pressure and can become visible and painful. Clotting of these veins can occur and is known as superficial thrombophlebitis.

Varicose veins can be treated in several ways. The use of compression stockings often relieves symptoms and may prevent the development of more varicose veins. When compression stockings fail to provide adequate relief, surgical therapy or sclerotherapy is usually necessary. An ultrasound test is usually performed to identify the veins that show valve abnormalities and is very helpful in determining treatment. Sclerotherapy involves the injection of a chemical agent into the involved veins to cause them to contract and close down. This treatment is usually reserved for patients with only a few small varicose veins. Surgical therapy is best suited for most patients with varicose veins because usually long segments of the superficial veins are involved. Traditionally stripping procedures have been used to remove the abnormal veins and are most often done in an outpatient setting. Newer techniques such as radiofrequency ablation and laser ablation cause the veins to close down without the need for removing them. Results are equivalent to stripping procedures with fewer incisions and less postoperative pain.

Spider Veins

Very small varicose veins are often referred to as spider veins. These veins are not generally treated by surgical procedures but rather by the use of lasers or sclerotherapy. Overall, sclerotherapy has the best long-term results in the treatment of spider veins. Most health insurance plans do not cover the treatment of spider veins since this treatment is considered cosmetic in nature.

Lasers and Varicose Veins

Lasers have been used in the treatment of varicose veins in two ways. As mentioned above, it is now possible to effectively close down long segments of varicose veins without the need for surgical stripping. Both laser and radiofrequency probes have been used successfully in this area. Lasers can also be used to treat spider veins but this may require several treatments and, in general, sclerotherapy provides better overall results.

Venous Ulcers

When venous insufficiency becomes severe it can result in the development of open sores on the legs. Most patients with this condition have venous insufficiency of the deep system of veins, sometimes in combination with insufficiency of the superficial veins. In some cases the venous ulcers can be associated infections. Treatment of these sores or venous ulcers is primarily directed at controlling the associated swelling and any infection. Most patients are initially treated with some type of compression dressing that is changed one to three times each week. With control of the swelling, the vast majority of these ulcers will heal. Once healed, compression stockings will usually control the swelling and prevent the ulcers from recurring. Surgery is usually only needed occasionally to clean the ulcers and in some cases to apply skin grafts to speed the healing process.

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