Venous Disease
Deep venous thrombosis (DVT) treatment • May-Thurner Syndrome treatment • Superficial venous insufficiency/Varicose vein treatment • Inferior vena cava (IVC) filter removal • Vascular malformation sclerotherapy
Venous Insufficiency and Varicose Veins
Blood is pushed back into the main circulation from the legs by the pumping action of the calf muscles over the leg veins. However, that alone is not enough to continuously achieve forward flow towards the heart. Normal veins have valves that keep the blood from moving backwards during the brief times the calf muscles are not being used. These valves may stop working properly for various reasons. As the calf muscles squeeze the blood forward, incompetent valves allow the blood to move backwards, resulting in pooling of blood in the lower legs. This is a medical condition referred to as venous insufficiency. Over time, the leg veins become dilated and twisted and do not control blood flow as they should. When the veins reach this state, they are referred to as varicose veins.
For many people, the only problem with varicose veins is cosmetic: they do not like the way it looks. However, if left untreated, the condition may progress and symptoms may worsen over time. Varicose veins can cause aching pain and discomfort, bruising, heavy and itchy legs, and swelling. In fact, venous insufficiency may cause some of these symptoms even without the appearance of varicose veins. When severe, venous insufficiency can lead to discoloration and wounds around the ankle.
The great saphenous vein is a large superficial vein of the leg that runs just underneath the skin from the ankle to the groin. It is the longest vein in the body and returns blood from the foot, calf, and thigh to the deep femoral vein at the level of the groin. In the great majority of cases, this is the vein that needs to be treated to improve symptoms from venous insufficiency and varicose veins. Occasionally, the incompetent veins may be the small saphenous vein or perforator veins that connect the deep venous system to the saphenous veins.
Treatments
Appropriate treatment of venous insufficiency and varicose veins relies greatly upon an accurate diagnostic assessment by your physician. This entails a comprehensive medical exam and ultrasound evaluation of your leg veins. Initially, a trial of conservative treatment with lifestyle changes and compression stockings is mandatory for your insurance to cover interventional therapies. If conservative treatment fails, we may use one or more of the following techniques:
A Vascular and Interventional Radiologist makes a tiny incision into the incompetent vein and introduces a catheter. The catheter generates heat from laser or radiofrequency energy and ultimately closes off the abnormal vein to further blood flow. This causes the blood to be redirected through normal veins and decreases the pooling of blood in the legs. As a result, the varicose veins regress and the symptoms of venous insufficiency improve.
Sclerotherapy is a popular method of eliminating varicose veins and “spider veins” in which a solution, called a sclerosing agent, is injected into the veins. The sclerosing agent irritates the inside of the vein, causing the vein to scar and ultimately fade from view. The blood is then rerouted through healthier veins. The number of treatments needed to clear or improve the condition differs from patient to patient and depends on the extent of varicose and spider veins present. Typically, multiple treatments are required for complete spider or varicose vein removal.
Ambulatory phlebectomy is used to remove large varicose veins near the skin surface. Small incisions are made to remove affected veins with small surgical tools. This procedure is often performed in conjunction with vein ablation and/or sclerotherapy. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia and typically takes under an hour.
Vascular Malformation
A vascular malformation is a type of growth often present at birth that is composed of a network of abnormal blood vessels and/or lymphatics. This can alter the normal function of the area by causing:
- pain
- swelling
- bleeding
- physical disfiguration
Similar to varicose veins and spider veins, these can be treated by sclerotherapy. Depending on the size of the vascular malformation, multiple sessions may be required.
Deep Vein Thrombosis (DVT) and May-Thurner Syndrome (Iliac vein compression)
Deep vein thrombosis is a potentially life-threatening condition that arises when a blood clot forms within a deep vein, usually in the legs. This most often results from slow blood flow in the legs, though sometimes blood clotting disorders can play a role. The most immediate concern regarding DVT is the risk that the clot could break off and lodge in the arteries supplying the lungs. A secondary concern is that a large inadequately treated DVT could lead to chronic deep vein damage, potentially resulting in lifelong pain and swelling in the affected leg or legs. This is a condition known as post-thrombotic syndrome (PTS).
Symptoms of acute DVT include:
- Leg pain
- New onset of leg swelling
- Focal tenderness
- Muscle cramps
Most patients diagnosed with DVT are initially placed on blood thinners that help the body get rid of the blood clots. However, when the clot is very extensive, often blood thinners alone are not sufficient or are slow to resolve the clot. This may lead to a prolonged symptomatic period and may put the patient at increased risk for PTS.
In this scenario, a Vascular and Interventional Radiologist can access the vein via a tiny skin incision in the back of the knee. A special catheter is then advanced into the vein and used to remove the clot, thereby restoring blood flow, alleviating the patient’s symptoms, and reducing the patient’s risk of PTS.
Occasionally, DVT in the leg can form due to a condition known as May-Thurner Syndrome. This “syndrome” is the result of an anatomical compression of the vein draining the left leg, which can be squeezed between the artery supplying the right leg and the spine. When this results in compression of the vein that is severe enough to cause DVT, it is referred to as May-Thurner Syndrome. The Vascular and Interventional Radiologist can treat this condition by placing a metallic stent in the narrowed area. A stent is a metallic mesh structure shaped as a cylinder that is delivered to the area of a venous narrowing or obstruction. The stent helps resolve the venous compression, and thus restores blood flow and reduces the risk of future DVT formation.
