Restless Legs or Venous Insufficiency?

Proper diagnosis and treatment lead to relief.

In an administrative position for a busy accounting firm, Patti* usually begins her workday around 8:00 a.m. The native of Michigan, who moved to Florida in 2003, typically had no trouble getting up and starting her day, but some mornings were tougher than others.
“I was experiencing problems with my legs about every two to three weeks,” she relates. “I’d have one of my sleepless nights where I’d fall asleep and wake up an hour later, or sometimes I just couldn’t fall asleep at all. My legs wouldn’t relax, and I could very well be up until three or four in the morning, which was very frustrating since I had to be at work at eight.
“It was very annoying. I couldn’t relax, and I would get up and walk around or change positions. I would finally get so tired, I’d fall asleep.”
Patti continued to live like this, thinking there was nothing that could be done. Her thinking was challenged when she read an article online. The article related how restless legs are a symptom of a vein disorder caused by leaking valves in the veins called venous insufficiency. This is the same condition that results in varicose veins.
“I’ve had some varicose veins for many years, but I didn’t realize they might have the same cause [as my restless legs],” states Patti. “The veins didn’t really hurt or anything. They were just not very attractive.”
Armed with this new insight, Patti did some additional research and made an appointment with Premier Vein Institute in Tampa.
The staff at Premier Vein Institute performed an ultrasound evaluation of her legs and diagnosed her with restless legs syndrome caused by venous insufficiency.
“They performed the ultrasound the day of my first visit and found out that I did have leaky valves, which was the root of the issue,” Patti recalls.

The Real Reason

Restless legs syndrome is not a disease. It is a syndrome, a pattern of symptoms in the absence of a diagnosable condition. The cause of restless legs syndrome is determined by ruling out all possible relatable disorders.
The most common condition associated with restless legs syndrome is venous insufficiency, which was the case with Patti. There are seven to ten million adults in the US who have been told they have restless legs syndrome, millions of whom have underlying vein disease that has gone untreated.
“The clinical presentation of restless legs syndrome includes an irresistible urge to move the legs, especially in bed at night,” describes Nestor Guerrero, ARNP, certified nurse practitioner at Premier Vein Institute.
“People who experience this typically have venous insufficiency because its symptoms are identical. The difference is, with venous insufficiency we can make a diagnosis with ultrasound.”
Nestor notes that restless legs syndrome is often associated with other symptoms as well. These include swollen, fatigued or heavy legs at the end of the day; nighttime leg cramps or Charley horses.
“The likelihood that the patient has venous insufficiency as the root cause of all of these things is significant,” informs Nestor. “There’s probably a ninety percent chance they have venous insufficiency.”
Nestor points out that there appears to be a disconnect in the health care community concerning the relationship between vein disease and restless legs syndrome. Many health care professionals are not addressing leaking valves as a potential cause for their patients’ symptoms.
Many patients are being told it’s not their veins because there’s nothing visible on the outside of their legs, when in fact they have severe vein disease inside. It’s just not manifesting in the classic way that physicians usually identify or recognize, such as varicose veins.
“Patients and physicians alike are not aware of how safe and simple it is today to detect and correct vein conditions,” elaborates Nestor. “At Premier Vein Institute, we can uncover the specific veins that are leaking and leading to symptoms during a quick and painless radiography procedure.
“Diagnostics are safe and scientifically directed now with ultrasonography. Then, we can correct the problem with a minimally invasive treatment called endovenous ablation.”

Today’s Treatments

In the past, the only treatment available to offer patients with venous insufficiency was surgical vein excisions, or vein stripping, which often required hospitalization and general anesthesia, along with an extended recovery period.
“Now, there is something we can do to fix the problem that is not invasive, is not a stripping, is not done in the hospital, is not done with general anesthesia and does not have a lot of complications or require a lot of recovery time,” notes Nestor.
Endovenous ablation, or endovenous closure, allows the treatment of leaking veins by sealing them with heat rather than stripping them out of the legs.
“With endovenous closure, there are no incisions, minimal to no pain and minimal scarring.”
Patti wasn’t sure what to expect when she went to Premier Vein Institute for this procedure. She was thrilled with how easy the process turned out to be.
“It was not painful at all,” she recalls. “They sealed the veins and took out some of the varicosities, and my legs were better immediately. I was very surprised because you’re nervous, having never had it done. It doesn’t really seem like a medical procedure. I was fully awake, and we talked about several topics.”
Not only was the procedure easy to tolerate, there was little downtime afterward, and that fit right into Patti’s busy lifestyle. She decided to have some of the unsightly veins on her legs treated and went back for a follow-up visit.
“I went to work the next day, and there were no problems,” Patti states.
Since her treatment, Patti’s symptoms have improved dramatically. She no longer has those nighttime bouts of restless legs, and she has many more good mornings.
“I’m sleeping a lot better now,” she reports. “The restless legs subsided like crazy. I used to have one of those bad nights every two to three weeks. Then, I was having them maybe once a month. Now, I can’t even remember when I had the last one because they are so infrequent.
“I’m very satisfied with the results, and I’ll continue to see Nestor if I have any other problems. I would certainly recommend Premier Vein Institute.”

Related Skin Conditions

After becoming an American citizen in 1992, Canadian-born Jackie* lived in many different areas of the United States before eventually settling in Florida. Since retiring from her home-based accounting business, Jackie is busier than ever.
“I golf four days a week, play mah-jong and get together with my friends, and I exercise two days a week,” she says, recounting her regular activities. “I volunteer at Hope Chest one day a week. I’m a busy lady.”
Jackie had issues with the circulation in her legs for years. She found herself struggling with restless legs, swelling, soreness and making multiple trips to the bathroom at night. However, she balked at the thought of going through what she believed would be a painful treatment process.
“I had quite a lot of problems for a long time and was not really comfortable with having any kind of treatment,” she admits. “Things progressed, to the point where I had to make a decision on whether or not to have my legs looked at.”
After doing some online research, Jackie scheduled an appointment at Premier Vein Institute. She was so impressed with what she was told at that appointment that she made an on-the-spot decision.
“Nestor was very personable,” Jackie remarks. “The staff is excellent and put me completely at ease. They are all very professional and have a wonderful bedside manner. Nestor told me what he could do for me and how simple it would be, and I said, Okay, let’s do it.”
“Like Patti, Jackie also had many of the common symptoms of venous disease – heaviness, swelling, aching, cramping,” informs Nestor, “but she also had a related skin condition called stasis dermatitis, thickening and discoloration of the skin around the lower leg just above the ankle.”
Nestor points out that many physicians believe that skin changes, such as stasis dermatitis, thickening or even ulcers, are symptoms of deep vein disease and that nothing can be done for the patient. That is not true, he adds.
“These patients deserve a good venous insufficiency evaluation,” he states. “Typically, it is not a deep vein problem. It is typically a superficial vein problem, meaning that it is something we can treat by ablating, or sealing, the faulty vein.”
This was true in Jackie’s case.
“We did a standard evaluation, which included ultrasound,” describes Nestor, “and that showed severe great saphenous vein insufficiency in both legs, and in the left leg, the small saphenous vein was leaking also.
“However, the ultrasound showed us the small saphenous vein was leaking only because there was a varicose vein branch that was connecting the great saphenous vein to the mid-calf small saphenous vein.”
The great saphenous vein is the main leg vein, and there are branches coming off it, such as the small saphenous vein. These are connected by branches called perforator veins.
“We did not have to seal the small saphenous vein because it was leaking secondary to the great saphenous vein,” Nestor notes. “Once the great saphenous vein was sealed, the branch no longer fed the small saphenous vein.
“We could have done two procedures on her left leg if we had just looked at the ultrasound report and did not really think about it. However, being focused on veins, we critically analyzed her ultrasound and realized that by sealing the great saphenous vein, we could correct the problem in the small saphenous vein because it would shut off the leaking branch that was feeding the small saphenous vein.”

Seeing and Feeling

Part of the body’s intricate circulatory system, veins are specially designed to pump blood back toward the heart, against the force of gravity. Inside these blood vessels are a series of one-way valves that open and close with the rhythm of muscle contractions.
Healthy valves close tightly, keeping blood moving upward toward the heart. With vein disease or venous insufficiency, the valves do not close properly. This allows blood to flow backward down the legs and pool in the veins. The pooled blood can lead to complications such as swollen, achy legs or leg cramping; “cankles” (where the distinction between calf and ankle is lost because of swelling), varicose veins, and skin changes that can lead to bleeding veins and leg ulcers. These complications are signs that vein disease is present.
“There are symptoms and signs of venous insufficiency, leaking veins or venous reflux disease,” Nestor educates. “The symptoms are what patients feel, and the signs are what patients see. Your legs get heavy as the day goes on. You feel like you’re having leg cramps in bed at night. You feel fatigue in your legs. Those are symptoms that patients often report.”

Restful Nights

Both Patti and Jackie found their procedures easy to tolerate and are thrilled at the excellent results they achieved.
“He did exactly what he said he was going to do,” Patti offers. “There was minimal discomfort, and the results are beyond amazing. My legs look like they’re eighteen years old. I’m ecstatic.
“I’m not waking up cramping anymore. All the issues I had are gone. I have no pain. I haven’t had ankles in probably thirty years, and I have ankles! I think he’s gold.”
Jackie’s experience at Premier Vein Institute was not unlike Patti’s. She marvels at her results and says they are more than she expected.
“I don’t have any more swelling in my ankles,” Jackie relays. “There’s no more pain. I don’t have tiredness in my legs. I should have had it done a long time ago, but it has only been three, maybe four years that the procedure’s been completely approved. I was there at the right time and had the right man do it. Now, everything is just great.”
Jackie, who was so afraid she would have to go through a painful surgery to have her legs done, now recommends treatment for anyone experiencing symptoms of vein disease.
“I was very fearful of having it done,” she remarks. “It’s a very, very simple procedure.”
Patti concurs with Jackie that Premier Vein Institute is top-notch for treatment of vein issues.
“I think the doctors and staff are remarkable,” she says. “I highly recommend them for any kind of leg vein issues.”

* Patient name withheld at their request
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