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According to the Society for Vascular Medicine, more than 30 million Americans suffer with venous disease, a disorder of the leg veins that impairs blood flow upward toward the heart.
“Venous disease is generally classified as superficial venous insufficiency, informs Charles I. Stein, MD, RPh, FACOG, a vein specialist at Vascular Vein Centers. “It usually involves the superficial venous system, which is near the surface of the skin, as opposed to the deep venous system that lies deep below the leg muscles.
“Venous insufficiency occurs when the one-way valves inside the leg veins fail and allow blood to leak backward toward the foot. The blood pools inside the veins and the pressure increases in the veins, causing them to leak. That also causes the leg veins to bulge and branch out, creating visible – and sometimes invisible – varicose veins.”
Other symptoms of venous insufficiency include swelling, leg heaviness, fatigue and darkening of the skin of the lower legs. Venous insufficiency also increases the risk for blood clots in the deep vein system and hard-to-heal venous ulcers on the surface of the skin near the ankle.
“The first step in any assessment of symptomatic patients is a medical evaluation,” Dr. Stein states. “It is important to identify any medical issues affecting these patients because other conditions can cause symptoms, most notably swelling in the legs. Heart disease and old blood clots can affect the patient and contribute to the swelling.”
After a medical evaluation, an ultrasound is performed to search for and map out any abnormalities in the patient’s venous system. The ultrasound produces real-time video images of the blood flow. If venous insufficiency is detected, a customized treatment plan is created for each patient.
Treatment may include endovenous laser ablation (EVLA) and chemical ablation. The latter utilizes a variety of solutions to close problematic veins. An example of chemical ablation is Varithena®, a procedure that seals problem veins using an FDA-approved microfoam that is administered under ultrasound guidance.
“Ablation is the term used for closing a vein,” Dr. Stein explains. “During EVLA, a small fiber is inserted into the incompetent vein with ultrasound guidance. Heat energy from a laser is then applied to the vein, sealing it. This eliminates the cause of the symptoms.
“The theory behind treatment is to close the bad veins knowing there are a multitude of good veins remaining. Until the bad veins are closed, circulatory return of blood to the heart is shared by the good veins and the bad veins. When we eliminate the bad veins, the return of blood through the good veins is more efficient.”
Venous insufficiency that causes life-disturbing symptoms is treated with medically indicated procedures that are typically covered by health insurance.
“In addition, there is no downtime after these procedures,” Dr. Stein reports. “Patients can resume normal activity with very few limitations immediately after treatment. In fact, when they walk out of our center, we recommend they continue walking and not go home to bed rest.”
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