- What
is Venous Disease and What Are Its Symptoms?
- How
Does The Venous System Work?
- What
Are The Two Venous Systems in the Legs
That Can Become Diseased?
- What
Causes Venous Disease?
- What
Are Risk Factors For Incompetent Veins?
- How
Can Incompetent Veins Cause Leg Swelling,
Leg Ulcers, and Infection?
- Are
varicose veins dangerous?
- What
procedures do you perform for ulcers of
the legs?
- Why
is laser treatment preferable over saline
injections?
-
What is vein stripping and when is it
necessary?
- Is
there a better alternative to vein stripping?
- What
types of venous procedures do Medicare
and other insurance providers cover?
- I
understand you offer a free initial spider
vein consultation and treatment. What
does that involve?
1.
What is Venous Disease and What
Are Its Symptoms?
A serious
form of vascular disease is venous
disease. Venous disease is often
confused with arterial disease,
limiting the effectiveness of treatment.
Venous diseases have not been emphasized
in the past. The correction of vascular
disease involving the venous system
is often regarded as “cosmetic
surgery.” Nothing could be
farther from the truth. Patients
with venous disease of the legs
have specific complaints and symptoms
that may include:
- Tired, aching
legs, usually best in the morning
and worse during the day especially
after prolonged standing or
sitting.
- Intolerance
to exercise
- Leg discoloration,
thickening and ulcers that are
difficult to heal.
- Spider veins,
varicose veins and leg swelling
from venous stasis.
2.
How Does The Venous System Work?
The heart pumps blood into the
arterial system. It travels to
the legs under pressure through
a system of arteries that becomes
smaller and smaller as it progresses
towards the tissues. Oxygen and
nutrient transfer and waste removal
is carried out through the smallest
arteries called capillaries. The
blood is then returned through
tiny veins that become progressively
larger as they move away from
the tissue and drain towards the
heart. The heart does not pump
blood out of the legs. Blood is
moved through the veins by contraction
of the muscles around them. As
each vein is compressed, the blood
moves in one direction towards
the heart. This one-way flow is
maintained by valves located at
intervals along the vein. The
valves only allow the blood to
flow one way, back towards the
heart for re-circulation.
3.
What Are The Two Venous Systems
in the Legs That Can Become Diseased?
There are two systems in the legs,
the surface or superficial veins,
and the deep veins. The superficial
veins are the ones that you see
just under the skin. They are
also the ones that become varicose
veins. The deep veins lie within
the large muscles of the leg.
They are connected to the surface
veins by short veins called perforator
veins. Perforator veins are called
this because they perforate the
thick coating around the large
leg muscles to reach the deep
veins. Blood from the skin drains
through perforator veins into
the large deep veins located in
the center of the calf muscle.
When you walk or exercise, the
calf muscle squeezes these large
veins and pumps the blood towards
the heart. Each perforator vein
has an important valve that allows
blood to flow from the skin into
the deep veins. This valve snaps
shut when the deep vein is squeezed
to prevent back flow of high pressure
blood to the delicate skin veins.
Valves in the deep veins keep
the blood flowing in one direction.
The venous system of the legs
is particularly well designed
to overcome the effects of gravity
and pump blood out of the legs.
It functions well as long as the
veins are not damaged.
4.
What Causes Venous Disease?
We now know that most of the vein
problems that occur are due to
increased pressure in the venous
system. This is actually high
blood pressure of the veins located
under the skin. This increased
pressure is caused by malfunction
of the valves that lie within
the veins. Dilation of the veins
is the problem. When the veins
become dilated, the valves, which
are attached to the sidewalls,
are pulled apart. They no longer
are able to maintain one-way flow
and prevent blood from draining
back toward the feet. These “leaking”
veins are called incompetent.
5.
What Are Risk Factors For Incompetent
Veins?
There are many reasons why veins
dilate and become incompetent.
Age is a primary factor. The walls
of the veins contain elastic that
allows them to stretch and contract
with the blood flow. As we become
older, the elastic slowly wears
out. It is also damaged by overstretching,
similar to a stretched out elastic
waistband on an undergarment.
If a vein is dilated beyond a
certain point, the elastic is
weakened and the vein walls no
longer are able to function correctly.
Veins are also dilated by certain
occupations that require standing
for prolonged periods producing
venous stasis. Nurses, auto mechanics,
store personnel and waitresses
are examples. These types of occupations
make high demands on the venous
system. In women, pregnancy plays
a major role. The increased pressure
in the lower abdomen during pregnancy
makes it difficult for the veins
of the legs to drain and creates
back pressure in the leg veins.
This back pressure dilates the
veins and is responsible for the
varicose veins that are often
seen during and after pregnancy.
6.
How Can Incompetent Veins Cause
Leg Swelling, Leg Ulcers, and Infection?
When a vein becomes incompetent,
gravity works to reverse the flow
of venous blood towards the feet.
Generally while one is walking or
exercising, the blood flow is normal
through the incompetent vein and
blood is moved out of the leg. However,
when one stands without exercising,
the flow in the incompetent vein
reverses and blood backfills the
lower leg. This restricts venous
drainage and results in high blood
pressure of the surface veins of
the leg. This is also caused by
dysfunctional valves in the perforator
veins that connect the skin veins
with the deep pumping veins located
in the calf. The pressure of this
blood is quite high and can cause
damage to the delicate skin veins
if it flows backwards towards the
skin. Each perforator vein has a
valve within it to prevent this
from happening. When these valves
become incompetent, high-pressure
blood from the deep system flows
towards the skin and produces high
blood pressure of the surface veins.
High blood pressure of the surface
veins produces major negative changes.
It causes the veins to distend over
time producing varicose veins. It
also increases the pressure in the
smaller veins causing these to stretch
and become very prominent. When
these are just under the skin, they
are known as spider veins. The increase
pressure causes the small veins
to leak fluid into the surrounding
tissues resulting in swelling or
edema followed by discoloration.
The high pressure is also transmitted
to the smallest veins that lie near
the capillary beds. This makes it
difficult for blood to flow across
the smallest vessels or capillaries,
thus disrupting the exchange of
nutrients and wastes in this area.
The tissues of the leg respond by
thickening of the skin and finally
by ulceration. A serious consequence
of this type of vascular disease
is Infection of the skin or cellulitis.The
good news is that patients with
vascular disease of the venous system
can be helped, even cured in many
cases.
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7.
Are varicose veins dangerous?
A: For the most part varicose veins
are not dangerous. However, large
varicose veins can lead to very
slow blood movement through the
dilated vessel. Blood has a natural
tendency to clot when it is moving
very slowly and therefore these
veins sometimes become filled with
blood clots. This condition is called
thrombophlebitis or simply phlebitis.
If present only in the superficial
veins under the skin, it is not
dangerous and usually will respond
to moist heat and elevation. If
the clot extends into the deep venous
system, it is considered dangerous
and therapy with blood thinning
medications is recommended.
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8.
What procedures do you perform for
ulcers of the legs?
Most ulcers of the lower legs are
caused by incompetence of perforator
veins in the calf. These incompetent
veins generally occur on the inside
of the ankle. Ultrasound scans performed
at our facility almost always show
incompetent perforator veins lying
beneath the ulcer. An outpatient
procedure known as subfascial endoscopic
perforator surgery or SEPS is recommended.
This minimally invasive procedure
is performed through a 1-inch incision
located just below the knee on the
inner calf. Through this incision
a small television camera based
system is inserted and the incompetent
perforator veins are closed with
titanium clips. The operation takes
less than 30 minutes. It is well
tolerated by patients and results
in the healing of ulcers in 94 percent
of patients.
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9.
Why is laser treatment preferable
over saline injections?
Treatment of spider veins with a
940 nm pulsed diode laser is an
extremely efficient way of removing
these unsightly veins. The laser
actually passes directly through
the skin and spider vein wall to
vaporize the blood within the spider
vein. This destroys the internal
vessel wall, which leads to obliteration
of the spider vein. The spider veins
turn red and gradually disappear
over the next 2-3 weeks. The treatment
is well tolerated and results in
minimum scarring and discoloration.
Saline injections also destroy the
internal vessel wall but have a
much higher chance of leaving permanent
discoloration. I treat many patients
who have had saline injections.
The majority of these patients prefer
the laser treatment.
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10.
What is vein stripping and when
is it necessary?
Stripping almost always refers to
the removal of the greater saphenous
vein which lies along the inside
of the thigh and lower leg. It is
a surgical procedure in which an
incision is made in the groin to
tie off and divide the top of the
vein. A vein stripper is then inserted
into the vein. It is generally pushed
through the vein above the knee
and brought through the skin by
a second incision. A small stripping
device is then connected to the
stripper and it is pulled back through
the leg tearing the vein out with
it. Pressure is then applied to
the leg to reduce bleeding. This
procedure is uncomfortable for the
patient postoperatively and may
result in bruising under the skin
that can take months to completely
resolve.
Vein stripping is
indicated for removal of incompetent
greater saphenous veins. These incompetent
veins allow blood to drain back
into the lower leg when one is not
exercising. This results in chronic
venous insufficiency symptoms of
the leg; swelling, pain, prominent
varicose veins, skin discoloration,
and eventually ulceration.
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11.
Is there a better alternative to
vein stripping?
Yes, at JVAI we utilize endoluminal
laser ablation of the saphenous
vein or ELAS. In this procedure
a small diameter laser filament
is inserted into the vein through
a needle puncture. This is done
right in our office with minimal
anesthesia. The laser filament is
connected to a laser system that
closes off the greater saphenous
vein from the inside. There is very
little trauma to the leg and almost
no bruising. Postoperative discomfort
is minimal. Patient satisfaction
is high. In fact, patients who have
had vein stripping of the other
leg have stated that they wish they
had waited until this laser technology
was available before having their
previous procedure.
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12.
What types of venous procedures
do Medicare and other insurance
providers cover?
Generally, the initial
consultation and any diagnostic
tests are covered. Most venous surgery
with the exception of spider vein
removal is generally covered by
insurance and Medicare.
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13.
I understand you offer an initial
spider vein consultation and treatment.
What does that involve?
This initial evaluation
allows me to determine whether or
not the patient has an underlying
venous problem that requires further
investigation. Patients who are
felt to have a more serious venous
problem are advised to make an appointment
for a formal venous evaluation that
is generally covered by their insurance
carrier.
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