The Root of the Problem

Frustrated by non-healing leg wounds? It could be your veins!

A year ago, Paula Gilland retired for the second time. She first retired at age 50 after 30 years as a Safeway® employee. She then went into the mortgage industry for 15 years before retiring again and relocating from chilly Denver to balmy Florida.

Photo by Jordan Pysz.

Paula Gilland

Paula was happy to finally retire for good and get off her feet after a 45-year career. She had issues with her legs that were aggravated by long hours of sitting and standing.
“When I was fifty, I developed a blood clot, a deep vein thrombosis, in my left leg,” she recalls. “Back in those days, they didn’t have the medicine that dissolves clots quickly like they do now. My doctor put me on a blood thinning medication, and I had to stay stationary until the clot dissolved.”
Thankfully, Paula didn’t suffer another blood clot, but after she moved to Florida, she began experiencing different problems with her legs, especially her left leg.
“My legs started swelling, and they were achy and stiff,” she reports. “I had bad cramps during the night, and my legs became very discolored. I also developed small, open wounds on my left leg that wouldn’t heal.”
The symptoms Paula was experiencing grew worse over time. Eventually, they concerned her enough to make an appointment with her primary care provider, who immediately referred her to Joseph G. Magnant, MD, a board-certified vascular surgeon who specializes in treating vein disorders.
Dr. Magnant’s practice, Vein Specialists, has offices in Fort Myers and Bonita Springs. It is dedicated to the comprehensive, modern evaluation and minimally invasive treatment of vein disorders.
When Paula initially arrived at Vein Specialists, Dr. Magnant performed an ultrasound on her legs and determined her veins were not sufficiently pumping blood upward, toward her heart. Paula had venous insufficiency.
“Venous insufficiency is when the valves in the leg veins fail, causing the flow of blood returning to the heart to be impeded,” educates Dr. Magnant. “As a result, the blood leaks out of the veins and pools in the legs, and may leak out of the veins into the surrounding tissues.
“Some of the signs and symptoms of venous insufficiency include varicose veins, swelling, achiness, heaviness, nighttime cramping, restless legs, discoloration of the skin and skin ulcers.

“The wounds I had are gone, and I haven’t had another one since Dr. Magnant’s procedures.” – Paula

“The first time I saw Paula, I treated the venous insufficiency in her legs using endovenous ablation, a minimally invasive procedure that uses heat (radiofrequency or laser energy) to seal off leaking veins. By correcting the underlying disease process and reducing the venous pressure to normal, the signs and symptoms often improve.”
The treatment was effective for Paula, at first. Yet the wounds on her left leg returned, leaving Dr. Magnant to suspect a deeper problem, and to consider a more definitive solution.

Three-Pronged Approach

“In most cases – probably eighty to eight-five percent – patients with wounds heal without further treatment once the ablation has been performed,” observes Dr. Magnant. “However, in Paula’s case, her wound did not stay healed. I started thinking about the possibility of disease higher up, in her pelvic region, that could be contributing to the problem.

Photo by Jordan Pysz.

Paula enjoys a good, healthy walk with her dogs

“An ultrasound was performed, and I found that she had a narrowing of her left iliac vein, on the same side as her open wounds. I then performed an IVUS intravascular ultrasound examination and discovered she had several blockages, and the pelvic (iliac) vein on the left side was nearly closed off. She was successfully treated with IVUS-directed stent placement and angioplasty.”
IVUS is a catheter-based ultrasound device. The catheter is a very slender tube with an ultrasound probe at its tip. The IVUS catheter is typically inserted into the femoral vein in the upper to middle thigh under ultrasound guidance. A guide wire with the probe attached is negotiated through the venous system upward toward the inferior vena cava.
The catheter is then slowly retracted, recording the area of the veins and determining whether significant narrowing is present and, specifically, which veins are involved. IVUS enables specialists to examine the veins from the inside with precision and accuracy, something not previously possible.
“The narrowing in the iliac veins affects blood flow in the leg veins and is responsible for the persistent swelling and skin discoloration that patients like Paula often experience,” explains Dr. Magnant. “After being diagnosed with iliac vein compression using IVUS, Paula returned for treatment of the condition with IVUS-directed stent placement and angioplasty.
“During her stent placement, the catheter was guided through her venous system from the femoral vein and upward into the compressed iliac vein, where the stents were placed. Balloons were inflated to enlarge the stents placed within the blood vessels even further.”
Paula responded well to the venous stent placement and experienced significant improvement in her symptoms. But her leg ultrasound showed she still had some small, leaking veins below her knee, where the previous ablations couldn’t reach. Dr. Magnant had a solution for that problem as well.
“Ultrasound-guided foam sclerotherapy was performed on the veins that were still open below her knee,” he acknowledges. “Ultrasound was used to guide a small needle into the vein just above her ankle, the sclerosing solution was then injected to close off the veins without any risk of damaging the surrounding nerves.
“For Paula, I took a three-pronged approach. When the first treatment did not get the desired results, I looked for higher disease – the pelvic compression – and treated that. Then, like many patients, she had the smaller veins that I treated with sclerotherapy.
“When all those sources of venous insufficiency were corrected, her wounds had a better chance to heal.”

Turn on the Light

After her series of treatments, Paula began to notice improvement in the way her legs felt and looked. They aren’t beautiful yet, but the skin discoloration is starting to fade.
“My legs feel really good now,” she shares. “I can really tell the difference in my right leg because the discoloration is getting lighter. My left leg was much worse, so we’re watching and waiting for that leg to start getting lighter as well.
“Since I went to see Dr. Magnant and received his treatments, the aching and swelling have really gone down. The wounds I had are gone, and I haven’t had another one since Dr. Magnant’s procedures. I also haven’t had any cramps in my legs in a long time.”
In addition to getting good results from her treatments at Vein Specialists, Paula also enjoyed a pleasant experience during her visits to Dr. Magnant’s office. She credits Dr. Magnant and his staff for making sure she was welcomed, comfortable and informed.
“I think Dr. Magnant is great, and I can tell the office is a very good place to work,” she relates. “The atmosphere is excellent, and everybody is very happy and helpful. I think they’re glad to be there.
“When I went in for my procedures, I was amazed at what
Dr. Magnant and his staff went through to prep me for the surgery. I was never nervous or frightened. Dr. Magnant is a wonderful man, and I had a wonderful experience. I recommend Dr. Magnant and Vein Specialists to anybody!”

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    • Vein Specialists

      Vein Specialists is 100 percent dedicated to identifying and treating vein disorders. Led by Dr. Joseph G. Magnant, they understand that the venous system varies between patients and consists of both deep and superficial venous systems and a net... Read More

    • Joseph G. Magnant, MD, FACS, RPVI

      Joseph G. Magnant, MD, FACS, RPVI, is a Fellow of the American College of Surgeons and is board certified by the American Board of Surgery in vascular surgery. He earned his medical degree from Medical College of Virginia. He completed a g... Read More