Can Varicose Veins Cause Leg Ulcers?

ulcer-before-1

VENOUS LEG ULCER, BEFORE: This is a venous leg ulcer, caused by venous reflux or venous insufficiency. In this picture, you can see varicose veins above the wound.

After

VENOUS LEG ULCER, AFTER: Because this individual had reflux only in the superficial varicose veins, treatment consisted of foam sclerotherapy of the varicosities and compression with unna boot dressing. The wound healed rapidly and note that the varicose veins are gone.

A venous leg ulcer is an open wound on the leg, caused by long-standing vein problems. It is the most severe form of chronic venous insufficiency (CVI). Venous leg ulcers are common, accounting for over 70% of all leg wounds. It affects 1% of Americans and is the seventh leading cause for disability in the United States.

It is usually located around the ankle (on the inner or outer sides). It is caused by underlying venous insufficiency, or venous reflux.  The persistent venous reflux (back flow of blood through faulty valves) causes high pressure within the leg veins.  The high pressure, is then exerting outward on the skin, causing an inflammatory response, eventually causing the skin to break down.  Visible signs of venous disease are varicose veins, ankle swelling, skin discoloration around the ankle and usually precede the leg wound.  Underlying venous insufficiency can be detected by duplex ultrasound imaging (a non-painful study).

The treatment of venous leg ulcers is to correct the underlying problem: the faulty veins. Treatment of the underlying non-functional veins will reduce pressure from venous hypertension, allowing the wound to heal.  There are a number of non-surgical treatment options that can accomplish this including foam sclerotherapy and endovenous ablation, depending on the affected veins. To determine if your leg wound is related to a vein problem or for treatment options, call us for more information.

How many veins can be treated before I run out?

 

Before

Before

 

 

The veins that can be treated are in the superficial venous system. These veins are located in the subcutaneous tissue and are only responsible for a very small amount of blood return from the legs. All of the diseased superficial veins can be treated because once these veins are closed, the blood is re-routed into the deep veins. The deep system is a more competent system and can accommodate all of the blood from the superficial veins. So, every last problematic superficial vein can be treated with great success.

I was told I have a Deep Vein Thrombosis (DVT), what does that mean?

I was told I have a Deep Vein Thrombosis-DVT, what does that mean?

A deep vein thrombosis (DVT) is a blood clot in one of the veins in the deep venous system. There are 2 types of veins in the legs, deep and superficial. Deep veins are deep within the muscle and are responsible for 90% of the blood return from the legs to the lungs and heart. These veins are necessary for life. Superficial veins are in the subcutaneous tissue and are not needed, therefore can be treated. Blood clots occur when the blood thickens and sticks together. A blood clot in the deep veins can break off and travel up through the bloodstream, becoming an embolism. The most serious and immediate concern is a pulmonary embolism, which is when the blood clot travels to an artery in the lungs and blocks blood flow. This can cause damage to the lungs or other organs and can cause death. A blood clot in the thigh is more likely to break off than a clot in the lower legs. A DVT is diagnosed by a venous ultrasound of the leg. A physician will decide if a blood thinner is needed for treatment of the blood clot based on a variety of factors. If a blood clot is suspected, an ultrasound is necessary immediately and a physician should be notified.

Why is Ultrasound Scanning Important With Small Vein Conditions?

a3

This picture demonstrates spider veins at the surface level may actually arise from veins that are not visible to the naked eye. These can be seen with ultrasound scanning.

Venous duplex ultrasound allows us to identify problems within the blood vessels that are not visible to the naked eye. Sometimes, the varicose veins or even small spider veins on the surface of the skin are just the ‘tip of the iceburg.’

What If I need my Great Saphenous Vein for Bypass Someday?

GSV1

The Great Saphenous Vein is a vein of the superficial venous system that drains blood from the skin and tissues into the deep system. It is most commonly the root of the problem in people with varicose veins. When the great saphenous vein is dysfunctional, removing it is the first step of vein treatment.

A great saphenous vein that needs treatment is not functioning properly. When a vein is diseased, the walls become weak and the vessel can dilate or grow triple its’ normal size. This is not the type of vessel that would be ideal to place in a diseased heart. While the saphenous vein is a common vein that is harvested for bypass grafts, there are other options such as the internal thoracic artery in the chest and the radial artery which is in the arm. With these options, an artery replaces an artery and the removal of the valves inside the veins is not necessary. It is important for the entire circulatory system to be functioning properly, together.

Why Do My Varicose Veins Hurt in Warm Weather?

Today, San Diegans experienced an unseasonable heat wave and gusty winds.  Many people with varicose veins may notice worsening leg pain today or with warm weather and heat in general.

The reason for this is that heat causes veins to expand and trap more blood. In unhealthy veins, such as varicose veins, the walls are weak allowing for them to relax and fill with blood.  The pooling of blood does not circulate well in varicose veins, causing increased pressure within the leg veins.  This can give the sensation of sluggishness, pain, aching, heaviness and swelling. Hot tubs, whirlpool baths, heated floors, sitting near a heat source and working in overheated rooms can all add to the problem.

 

Dr. Fronek Hosts PBS Special On Vein Care

Watch La Jolla Vein Care’s Dr. Fronek on PBS’s special on vein care, ‘Ask A Vein Expert- A Phlebologist’ to learn more about venous disease. More than 80 million Americans suffer from some type of vein disorder. More than 30 million people are undiagnosed with varicose veins or venous insufficiency.  Are you one of them?

Watch Dr. Fronek and colleagues on PBS to understand more about vein conditions and treatment options on the ACP websitePBSSpecial

 

 

What is a Venous Duplex Ultrasound Examination?

GSV

This is a normal ultrasound examination. It is negative for venous reflux in the great saphenous vein.

Ultrasound Doppler Signals

These doppler signals demonstrate 3 seconds of backflow or retrograde flow through incompetent valves. This test is positive for venous reflux in the great saphenous vein.

An ultrasound is a type of noninvasive test that uses sound waves to “see” inside your body, without being exposed to radiation. For this specific exam, it is to see how blood moves through your veins. It can evaluate symptoms including leg pain or swelling, varicose veins and suspected blood clots. There is no preparation needed for this ultrasound and there are no associated risks involved. The test is performed both lying down on a table and/or in the standing position. A technologist will apply a special gel to the entire area that is going to be examined. Then the ultrasound wand is pressed against the skin and moved back and forth. Sometimes the pressure can cause some mild, temporary discomfort, but most people find the test to be completely painless. As the wand is moved up and down the leg, images and videos are being projected onto the monitor and stored. The test takes between 20-50 minutes and there are no special instructions after it is completed, you should resume all normal activities. In a venous exam, particular attention is paid to the function of the valves inside the veins. These valves act as one-way gates for blood to travel up the leg. When a vein becomes weak it dilates causing the valves to leak and not close properly, resulting in a back flow of blood. This is called venous insufficiency or reflux. Reflux is most common in our superficial venous system; in our great saphenous vein and small saphenous vein. When reflux is identified in these veins, it can be treated with great success by a vein specialist.

Non-surgical Varicose Vein Treatments Mean Quicker Recovery

ljvc-slider-4

One of La Jolla Vein Care’s incredible patient returned to surfing just two weeks after varicose vein treatment.

Over the past decade, advances in the treatment of vein conditions have improved the safety, efficacy, comfort and success of therapy. Newer procedures have replaced old-fashioned vein stripping surgery.  In 2008, a statement by the American College of Phlebology announced that these newer methods, called endovenous procedures are considered the ‘new standard of care,’ replacing vein stripping surgery. Modern vein treatments are performed in the office, without anesthesia, and return to normal activities is almost immediate.  The average procedure time is 60 minutes.   There are several different treatment options depending on the type of veins, extent of disease, your ultrasound findings and other factors.  Normal activities and regular walking can be resumed immediately after vein treatments, whereas, return to heavy rigorous exercise, such as running and spinning is about two weeks.