A large spectrum of venous disease exists and appears in various manifestations in patients of all ages. Varicose veins are superficial limb veins that have become stretched and swollen with blood. It is one of the most common vascular diseases in industrial countries. Multiple factors contribute to the development of varicose veins and include hereditary (family history) and environmental factors (occupation with prolonged standing, pregnancy etc). Other venous diseases include small reticular veins within the skin, deep vein thrombosis (DVT) and post thrombotic syndrome with one of the most devastating complications including skin ulcer. Also, pulmonary embolism might be associated with lower limb DVT.
WHAT DOES VENOUS INSUFFICIENCY CAUSE?
Most patients suffer from subjective symptoms like pain, soreness, burning or aching and sometimes even cramping pain and tiredness of the feet and legs. Swelling is often present. Over time, chronic non-treated venous insufficiency leads to cutaneous changes in terms of brown skin colouring or even soft tissue breakdown, which is known as ulceration.
HOW IS VENOUS INSUFFICIENCY DIAGNOSED?
Following a clinical appointment an ultrasound scan is requested and results are discussed with the patient. Further and more detailed assessments are needed in complex cases where previous surgical procedures have been performed or deep vein thrombosis has caused skin ulcerations and reconstruction of deep veins is planned.
HOW IS VENOUS INSUFFICIENCY TREATED?
Small skin veins can be treated for mainly cosmetic reasons by sclerotherapy on an outpatient basis. Varicose veins are usually treated with a surgical procedure and it is, most of the time, also an outpatient procedure. The goal of this operation is to remove insufficient (incompetent) veins that are causing symptoms, including those that are cosmetically unacceptable for the patient. The surgical procedure can be performed either under general anesthesia or local anesthesia. It consists essentially of one skin cut in the groin, or behind the patient’s knee and multiple small punctures. Through those small punctures incompetent veins are removed and the leg is then softly bandaged. Recovery time is about a week at home. Hospital stay is not required for the average, healthy patient.
The most advanced technology available involves using a laser or radiofrequency energy to seal larger faulty veins with no incision. This technique is available for most patients in our practice. Foam sclerotherapy and/or removal of the varicose veins can be done simultaneously or in stages, also under local anesthetic.
Deep vein reconstruction is sometimes necessary to improve venous circulation and heal long-lasting leg ulcers. Most commonly an endovascular venoplasty and stenting is used to repair obstructions in the deep veins. The procedure is very similar to one used for arterial occlusive disease (please see Peripheral Arterial Disease, balloon angioplasty). Specific surgical procedures are sometimes needed for patients with leg ulcers in cases where previous superficial vein surgery wasn’t successful. This procedure is mainly performed using minimally invasive techniques such as endoscopy and Subfascial Endoscopic Perforator Surgery.
In acute DVT situations where the large pelvic vein is affected, an intervention (thrombolysis) is also advised in order to ‘de-clot’ the vein, restore the vein’s flow, avoid a leg ulcer and chronic swelling associated with pain.