Diagnosing & Treating Venous Insufficiency in Houston, TX
The function of veins is to bring blood back to the heart. There are two systems of veins in the legs – Deep Veins (those veins beneath the muscle) and Superficial Veins (those veins above the muscle). Just because is a vein is beneath the surface, it isn’t necessarily a deep vein. There is a space between the skin and the muscle, where superficial veins also reside.
Deep veins account for 90% of blood return, from the legs, to the heart. Superficial veins are above the muscle and account for only 10% of the blood return to the heart.
When vein function is normal, blood is pumped up the legs, by the calf muscle, as it contracts, when you walk. The veins have a series of one-way valves that allow blood to flow one direction, up and not down. The valves also allow the blood to flow from the superficial veins to the deep veins.
When the valves are not functioning properly, blood flows in two directions, up and down. They also allow blood to flow from the deep veins to the superficial vein.
Reflux is term used to describe this abnormal two-way flow. This leads to blood, pooling in the leg veins. The pooling of blood causes a build up of pressure, resulting in bulging, varicose veins.
Over time, this increased pressure in the veins causes increased pressure in the leg as well. This increased pressure results in swelling, and as it progresses, the skin gets thicker and darker as well. Once it reaches this stage, patients are at risk for development of an open wound near the ankle, referred to as a venous stasis ulcer.
When a person has reflux and associated varicose veins, or other conditions described above, we say that the person has venous insufficiency. Venous insufficiency is the medical diagnosis used for the abnormal vein function described above.
The most likely cause of bulging veins is reflux in the greater saphenous vein. The greater saphenous vein is a superficial vein, which extends from the ankle to high in the thigh where it empties into the femoral vein – a deep vein. There is also a lesser saphenous vein, which is a superficial vein, in the calf, in the back of the lower leg. It empties into the popliteal vein, a deep vein, under the crease, behind the knee.
Evaluation of Venous Insufficiency
Treatment begins with proper evaluation. A complete history is taken. This includes a family history of vein problems or clotting disorders. Use of birth control and hormone replacement are also important. Sedentary lifestyle is a contributing factor. Other important aspects are a history of phlebitis and blood clots. If a person has swelling it is important to know whether the swelling goes down at night.
A physical exam is performed, noting swelling, skin changes and abnormal visible veins. The pattern and location of abnormal veins can provide a clue to underlying abnormality.
We then perform a venous ultrasound of your legs. The ultrasound is vital in assessing your leg veins. During the ultrasound examination, the deep and superficial veins are examined for blood clots and for function, or any abnormalities involving your leg veins. This provides vital information regarding what treatment would be most effective for you.
The diagnosis of venous insufficiency is confirmed by performing an ultrasound examination, with the patient in a standing position. The long saphenous vein extends along the inner aspect of the leg and thigh, and empties into the deep vein, the femoral vein, near the crease in the upper thigh. The femoral vein is examined to ensure that there are no clots and that it is functioning properly. Measures are taken along the length of the saphenous vein. Functions of the veins are evaluated by performing compression maneuvers on the calf muscle of the leg being evaluated.
The saphenous vein is also evaluated to determine normal or abnormal blood flow. If the flow of blood is going in both directions there is venous reflux, and the presence of reflux is what we use to diagnose venous insufficiency.
Treatment of Venous Insufficiency
If a person has an abnormal appendix or gall bladder, the abnormal organs aren’t repaired – they are eliminated. The same principles are applied to treating an abnormal leg. The abnormal veins aren’t repaired – they are eliminated.
Elimination can only be performed on the superficial veins. This can be done safely on the superficial veins because 90% of the blood return in the legs is through the deep veins. This is effective because in the vast majority of cases, the abnormal veins are superficial.
Because the saphenous vein is responsible for venous insufficiency, and it’s manifestations about 80% of the time, treatment of the venous insufficiency, can be accomplished by eliminating the saphenous vein.
In the past, the treatment of venous insufficiency involved stripping the long saphenous vein. It was a surgical procedure, which involved disconnecting the saphenous vein from the deep vein and pulling it out. This was performed in a hospital operating room and required a general anesthetic.
A new class of minimally invasive surgical procedures referred to as endovenous thermal ablations is now utilized to replace vein stripping procedures. These procedures can be performed by using laser or radiofrequency energy. The laser procedures are often referred to by names given to them, by the laser manufacturer. These names include: EVLA (Endovenous Laser Ablation), EVLT (Endovenous Laser Treatment), ELAS (Endolumenal Laser Ablation Saphenous). The radiofrequency treatments are most commonly referred to as the VNUS Closure.
The technical details of the procedures are similar. The patient’s veins are mapped using the venous duplex ultrasound, while the patient is standing.
The patient is then taken to the procedure room, lies down on the table and the leg is prepped and draped under sterile conditions. Ultrasound is used to guide placement of the laser fiber into the vein.
The vein is entered lower in the leg, and the laser fiber is advanced up the vein, to about 2 cm below where it enters the deep vein.
Local anesthesia is injected into the tissue surrounding the vein, extending along the entire length of vein intended for treatment. The local anesthesia also forms a protective layer between the vein and surrounding tissue, to absorb laser energy. The laser is then activated and slowly withdrawn from the vein. As it is being withdrawn, the laser energy seals the vein.
At the completion of the procedure, butterfly tapes are applied to the insertion site, the legs are wrapped and the patient simply walks out of the procedure room.
The average procedure time takes about 30-45 minutes.
Call Texas Vein & Cosmetic Specialists today to schedule your initial evaluation.