Venuous Insufficiency/Varicose Veins
Venous insufficiency is a condition in which the leg veins do not effectively carry blood back to heart. It is mainly caused because of a problem with valves in the vein which normally help in moving the blood from the leg to the heart and prevent any back flow (reflux) in the leg. Due to the problem with the valves and the vein, the blood starts to pool in the legs causing leg venous blood "congestion." The patient usually complains of pain, swelling, varicose veins, and ulcers. This conditioning can be incapacitating and painful, limiting the person's daily lifestyle.
Mount Sinai provides comprehensive and personalized care to the patients with vein disease. With our team's vast expertise, Mount Sinai has made a mark for itself in the field of vein medicine. We believe in providing complete care at one location: scheduling an appointment with one of the experts for initial evaluation, scheduling tests like Duplex scan and coming up with a tailored plan which best suits your needs. We have all the latest devices needed for a successful treatment of the venous disease.
Venous Insufficiency Risk Factors
Venous insufficiency is mainly seen in patients who are obese, pregnant, have a prior history of clot in the legs, history of trauma to the leg or prior surgery of the leg. Other factors that might contribute to this disease include older age, tall stature, women (related to progesterone hormone), smoking, sitting or standing for a long time, inflammation and swelling of the superficial veins (phlebitis).
Venous Insufficiency Symptoms
Symptoms of chronic venous insufficiency include:
- Pain – throbbing, aching, cramping, or heaviness in the legs at rest or walking, which improves with elevation of the leg
- Redness or discoloration of the legs
- Slow healing wound on the legs and ankles
- Spider veins
- Swelling of the legs/ankles
- Thickening and hardening of the skin
- Ulcers on the legs and ankles
- Visible engorged veins (varicose veins)
Diagnosing Venous Insufficiency
The first step in diagnosing the disease is by seeing a vein specialist. After a thorough history and physical examination, the doctor will determine if you need further testing to confirm the diagnosis. In there is high suspicion of disease based on physical examination, one of the diagnostic tests performed is a Duplex ultrasound. This is an office-based non-invasive test, which detects blood flow in the veins and determines the degree of reflux. This helps in confirming the diagnosis and initiating appropriate treatment.
Venous Insufficiency Treatments
There are a number of venous insufficiency treatment options available, depending on the stage and the extent of the disease. Early stages of the disease can be managed conservatively, while advanced stages of chronic venous insufficiency require more aggressive minimally invasive or surgical procedures.
Based on the assessment by your physician you might be managed by the following steps:
- Avoiding long periods of sitting or standing
- Care of the wounds and ulcers
- Lose weight, in the case you are overweight
- Use of diuretics (fluid pills) to decrease swelling in the leg
- Wear compression stockings (mainstay of treatment)
In case your physician determines that disease is advanced, there are minimally invasive procedures available which are known to clear the disease with more than a 90 percent success rate. These are day procedures, done in the office setting and requiring no anesthesia. A few of the treatment options available include:
- Endovenous thermal ablation: This is a highly efficacious and durable office-based procedure that has become the treatment of choice in patients with advanced chronic venous insufficiency. A catheter is introduced in the vein under local anesthesia and, by using a radiofrequency or laser technology, it burns and hardens the vein from inside. Eventually, the veins disappear and the disease is gone.
- Sclerotherapy: This is an injection of chemical agent in the veins. This procedure hardens the vein, and the varicosity disappears with time.
- Stab phlebectomy: This is less commonly used procedure, in which small cuts are made over the dilated veins and then removed through these incision sites.
- Surgical options: These procedures include vein stripping, ligation, surgical repair, and vein transplant.
Division of Vascular and Endovascular Surgery
Vascular Interventions – Cardiac Cath Lab