Chronic Venous Insufficiency (Varicose Veins)
This is an issue affecting roughly 25 million Americans. Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis. This condition affects about 25 million people (5%) of the US population. It usually occurs in men between the ages of 40 to 79 and in women between the ages of 40 to 69. CVI causes characteristic changes, called lipodermatosclerosis, to the skin of the lower extremities, which lead to eventual skin ulceration. Chronic venous insufficiency does not generally pose a serious health threat, but if left untreated CVI can lead to chronic life-threatening infections of the lower extremities. Some studies estimate that 500,000 people in the US have ulcers of the lower legs that are a result of this condition.
Once Vein Problems Start
Once vein problems start, they will not disappear, but only become worse with time. The most common form of preventive treatment is with compression from graduated compression stockings. Those who stand all day benefit from graduated compression stockings the most. Once varicose veins exist, compression stockings can alleviate the symptoms of aching pain, cramping, or swelling. They can also deter the progression of more serious venous changes.
What are the causes of CVI?
- Being female (related to levels of the hormone progesterone)
- Being tall
- Genetic factors
- History of deep vein thrombosis in the legs
- Sitting or standing for a long time
What are the symptoms of Chronic Venous Insufficiency (CVI)?
- If you have CVI, your ankles may swell and your calves may feel tight, relieved with elevation. Your legs may also feel heavy, tired, restless, itchy, or achy. You may feel pain while walking or shortly after stopping.
- CVI may be associated with varicose veins. Varicose veins are swollen veins that you can see through the skin. They often look blue, bulging, and twisted. Large varicose veins can lead to skin changes like rashes (stasis dermatitis) , redness (brawny edema, hemosiderin deposits, lipodermatosclerosis), and in severe cases, CVI can cause ulcers (skin break down) to form on the lower parts of the leg.
- CVI can also cause problems with leg swelling because of the pressure of the blood pooling in the veins. Your lymphatic system may also produce fluid, called lymph, to compensate for CVI. Your leg tissues may then absorb some of this fluid, which can increase the tendency for your legs to swell.
- It has been reported that 67% of all lymphedema is directly related to venous disorders. More than 7 million Americans have venous-related lymphedema
The conservative approach in treating varicose veins is to help support the venous circulation of the legs in order to slow the development of new veins and to minimize symptoms. Conservative treatment methods will not cure or eliminate existing vein problems. However, they will help slow the progression of the disease and alleviate symptoms such as swelling, aching, and cramping. As a result, they are viable alternatives to medical treatment for people who are sick, elderly, or pregnant.
The choice of medical treatment depends on the type, size, location, and depth of the vein problem as determined by various non-invasive diagnostic tests, such as venous Doppler, and color duplex ultrasound. All necessary diagnostic testing is performed in the office. Through physical examination and diagnostic testing, we choose one or more treatment methods to achieve the desired cosmetic results. We will track your progress with digital imaging throughout your course of treatment.
Endovenous Laser (EVLA) and Radio Frequency (RF)Ablation
Endovenous laser (EVLA) and Radiofrequency (RF) ablations are a non-invasive laser procedure that can be performed at First Coast Cardiovascular Institute in about one hour. After the procedure, you can walk out and resume normal activities. This technique treats the underlying causes of varicose veins and has a 98% success rate after the first visit. Due to the technology used, endovenous thermal ablation we are able to treat a large range of vein sizes. The procedure can be done in our office or in extreme cases our own free standing catherization laboratory. You will experience minimal, if any, pain, bruising or post-op complications and the success rate is 98-100%
The key benefits of Laser or Radiofrequency Ablation
- A simple procedure performed under local anesthetic
- Minimally invasive, so minimal risk of scarring and postoperative infection
- Less than one hour total examination and treatment time
- Rapid recovery with reduced postoperative pain
- Normal activities can be resumed immediately
- Excellent clinical and aesthetic results
Ultrasonic Guided Foam Sclerotherapy
This is a new advancement in the treatment of difficult venous problems. Veins that are not amenable to thermal ablation can be eliminated with Duplex Doppler Ultrasound guidance of a small needle that injects a FOAM Sclerotherapy. The FOAM acts to close the vein. It is safe and takes a few minutes to perform.
The classic vein stripping is no longer used. Instead, the remaining or persistent Varicose veins are removed with a small crochet hook through tiny need puncture. The resulting improved clinical and cosmetic effects are a quick recovery, no large scars, and no down time.
What Are the Treatment Goals
- Reduce the risk of ulceration and recurrent skin breakdown
- Also aids in wound care
- Reduce edema and limb swelling
- Resolution of secondary lymphedema
- Resolution of Restless leg
- Resolution of Pain, and Burning