Swelling and heavy, aching legs are also hallmarks of venous reflux disease, but can sometimes be mistaken for musculoskeletal and other problems. Spider veins do represent a form of reflux disease, but despite itching and burning that can accompany cosmetic concerns, do not constitute a medical problem in the eyes of insurance companies.
 What causes varicose veins and venous reflux?
The underlying problem, common to most of these patients, is venous valvular incompetence or, in other words, floppy valves. Valves are present in the heart and veins to facilitate unidirectional flow that maintains efficient circulation. Incompetent valves in the heart are responsible for regurgitant flow, which can lead to dilated heart chambers that can ultimately impair heart muscle contraction. Similarly, veins which are responsible for returning blood that has been distributed to the body will dilate in response to incompetent valves.This impairs venous function, delaying return of blood to the heart and overloading the tissues in the leg which causes congestion. Heredity, female gender, pregnancy, weight, and professions that require prolonged standing and sitting are contributing factors. Men are less often affected than women, but still comprise a significant number of patients with venous reflux.
Who is affected?
Venous disease is not a small problem. It occurs twice as often as coronary artery disease and five times more often than peripheral artery disease in the United States. Venous disease is quickly recognized in patients with large protruding varicose veins, but in their absence, venous disease can be overlooked and interpreted as another problem. The face of venous disease can be a 30-year old woman, thin and healthy appearing, with a history of multiple pregnancies. It can also be a 30-year old man with four years of recurrent ankle ulcers and severe skin changes. And, then again, it can be a 61-year old woman with a ten year history of leg pain misdiagnosed as neuropathy and fibromyalgia. In some cases, varicose veins are dismissed as a cosmetic problem.
Venous insufficiency can significantly impact lifestyle. Occupations that require long periods of standing or sitting, thought to contribute to the development of venous reflux, provoke intolerable symptoms of aching fatigue, throbbing, swelling, skin changes, and ultimately painful ulcers. Salesmen, teachers, hairdressers, nurses, and military personnel are among those affected. Market research indicates that over 2 million workdays are lost annually in the US and $1.4 billion is spent each year on this common medical condition.
Of the 25 million Americans with venous insufficiency, approximately 7 million exhibit serious symptoms such as swelling, skin changes, and venous ulcers. It is estimated that 72% of women and 42% of men will experience varicose veins by the time they are in their 60s. Prevalence is highly correlated to age and gender.
 What are the symptoms?
Varicose veins often herald the presence of venous reflux, but not always. Legs can ache and fatigue due to reflux without the obvious bulging veins. Discomfort usually worsens toward the end of the day. Symptoms vary too. Sometimes, restless and aching legs at night are the predominant complaint. Although few patients describe pain per say, the discomfort can be fairly disturbing and interfere with desired activities, including exercise, work responsibilities, and keeping up at family events. People in their fifties and older occasionally dismiss the symptoms to aging and ‘slowing down.’ Other features of venous reflux disease include burning and itching skin of the lower extremities, leg swelling (edema), skin changes including darkening and thickening, and ulcers usually at the ankle level.
What are the answers?
Recommendations are generated based on individual case histories, physical exam, and usually duplex ultrasound evaluation. The long outflow veins that comprise the major superficial outflow system often are the root of the problem and the underlying source of reflux. Therefore, effective treatment requires addressing these veins, the greater and short saphenous veins. The current method of treatment involves an office-based procedure whereby the vein is closed under ultrasound guidance, otherwise referred to as endovenous ablation. The procedure is tolerable and often equated to a trip to the dentist. Ambulatory phlebectomy, excising varicose veins directly through small incisions, is performed either at time of the ablation, or as a separate procedure. A common question is whether closing the saphenous veins is safe and will it interfere with circulation. Not only is it safe, closing a refluxing vein will improve venous circulation, as it reroutes returning blood to more normal, competent veins. Most insurance companies cover the procedure, as does Medicare.
A necessary part of treatment involves compression therapy. Although most people are loath to wear compression stockings, especially in the heat, they do have an important role. Aside from the fact that insurance companies typically require a mandatory trial of compression therapy before approving any recommended treatment, they provide reassuring confirmation that further treatment will translate into clinical improvement. Also, wearing compression stockings is important for several weeks after procedures to improve outcome and achieve desired objectives.
Sclerotherapy serves as an additional treatment in venous reflux or as a stand alone procedure for the treatment of spider veins. Sclerotherapy involves injection of a chemical solution into a vein that results in collapse and eventual disappearance. Treatment of spider veins often requires several sessions to achieve desired results. It is important to understand that results of sclerotherapy occur over months, a concept that is not always made clear on the front end. Photographs are commonly used to document improvement.
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|  Susan Hancock, MD is board certified by the American College of Surgeons and has practiced as a Vascular Surgeon for three years since completing her Vascular Fellowship in 2007. She now has an independent practice in the Oyster Point area dedicated to the treatment of venous related disorders including varicose veins, ulcerations, dermatitis and infections, swelling, aching uncomfortable legs, and spider veins. She is experienced in vascular ultrasound, radiofrequency vein ablation with the VNUS Closure system, surgical excision of varicose veins, wound care, sclerotherapy, and radiofrequency treatment of spider veins.
11838 Rock Landing Drive, Suite 100
Newport News, VA 23606
Phone: 757-873-0138 | Fax: 757-873-0246
www.hancockvein.com |
