Complications of Untreated Varicose Veins #5: Swelling

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Leg swelling is a common symptoms of varicose veins and venous insufficiency. The legs often feel heavy. It is common to notice sock lines around the ankles by the end of the day.

Complications of Untreated Varicose Veins and Venous Insufficiency #5: Swelling of the Ankles/legs

Leg swelling (swelling is also known as edema), is a common complaint related to varicose veins and underlying venous insufficiency. Leg swelling can be present simply from underlying venous insufficiency without visible signs of varicose veins or spider veins. As a result, a venous insufficiency study by duplex ultrasound scanning is part of the recommend work-up for leg swelling.  The swelling usually affects the ankles.  Most people with vein-related swelling experience progressive swelling throughout the day, that is worse at night time and improved in the morning (they usually wake up with normal appearing legs in the morning but by night-time, shoes may feel tight.) Vein-related swelling is worse at the end of the day, with prolonged standing, sitting or with air travel, heat and menstruation.  The degree of swelling varies from one person to another.

Compression stockings and legs elevation will help reduce swelling.   If the swelling can be attributed to the varicose veins or venous insufficiency, correction of the underlying vein problem will reduce swelling.

Complications of Untreated Varicose Veins #4: Leg Ulceration

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Venous leg ulcers make up 70% of all chronic leg wounds. They usually occur in the inner ankle or outer ankle locations.

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Before and after treatment of a venous leg ulcer.
Copyright @ La Jolla Vein Care.

A leg ulceration is the most severe form of chronic venous insufficiency.  This is referred to as a ‘venous leg ulcer.’  Venous leg ulcers make up 70% of all chronic leg wounds.  Therefore, the venous leg ulcer is much more common than a diabetic or arterial ulcer.  It is caused from long-standing pressure within the leg veins, resulting from 1) venous reflux through faulty valves, 2) a blockage within the deep veins or 3) from the inability to use the calf muscles or a combination.  Venous reflux is the most common cause for a venous leg ulcer.  The increased pressure within the leg veins (we call this venous hypertension) causes an inflammatory response. Inflammation then causes changes in the skin, usually around the ankles (this is where pressure is the greatest).  The inflammatory process will cause the skin around the ankles to become brown or discolored, and eventually the skin will break open.  The leg wound can be healed by treating the underlying vein condition.  Venous leg ulcers can also be prevented by early intervention with non-invasive procedures.  If you have signs of chronic venous insufficiency (such as skin discoloration around the ankles) you should address your underlying vein condition to prevent the skin from breaking open.

Complications of Untreated Varicose Veins #3: Spontaneous Bleeding

Complications of Untreated Varicose Veins #3: Bleeding or Hemorrhage Caused by Vein Rupture

Untreated varicose veins are at a higher than usual risk of bleeding or spontaneous rupture.   Over time, varicose veins become larger, and the vein wall becomes weak and stretched out. These veins, which are already weak are also under high pressure (because of venous reflux, or the ‘backflow’ and pooling of blood in these veins). As a result, the high pressure can cause the veins to spontaneous burst and bleed heavily. Because they are under high pressure, they bleed like an arterial bleed and patients describe the bleeding as ‘blood shooting across the room.’  The varicose veins that are susceptible are veins closest to the surface of the skin

Most patients describe that it occurs during or after a warm shower (warm water causes veins to relax and dilate, allowing more blood to pool within the veins) or during sleep. It is painless and patients report that they notice it because they feel something wet in bed.  Patients who are on blood thinners can lose large amounts of blood, especially if it occurs while they are sleeping. Some people have required blood transfusions. The small blue spider veins around the ankle are equally at risk of rupture as are the larger bulging veins.

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This is a patient who experienced spontaneous hemorrhage of their varicose veins. Notice the appearance of the blue, bulging veins that we describe as, ‘blue blebs.’ These veins are dilated, weak, and are close to the surface of the skin. The pooling blood within these veins causes high pressure, ultimately resulting in a spontaneous rupture or hemorrhage. The bleeding is rapid since varicose veins are under high pressure.  This is a common condition that we see at La Jolla Vein Care.

If someone you know has experienced bleeding from their varicose veins, they should be seen by a doctor. Treatment will prevent the veins from bursting again.  This is a common condition that we see at La Jolla Vein Care.

How Much Does Spider Vein Sclerotherapy Cost?

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Before and after spider vein treatment with sclerotherapy at La Jolla Vein Care.

At La Jolla Vein Care, we offer a cosmetic spider vein clinic staffed by our Registered Nurse or Physician’s Assistant, who perform the treatment of those small, pesty spider veins.  Everyone is different, and each person will have individual needs. Therefore, the cost depends on how much solution is required to obtain best results.  The treatment starts at $100 for the first vial of solution. One vial will treat approximately a ‘tuna can’ size cluster/s of spider veins.  Each additional syringe is $75.  The maximum solution that can be used during a single treatment is 5 syringes.  Most people will need more than one treatment session for best results. Everyone is different, so the amount used each treatment and how many treatments will be necessary depend on the individuals vein condition. The national average is 2-5 sclerotherapy treatment sessions. Call 858-550-0330 to speak with our staff for more information.

Complications of Untreated Varicose Veins #2: Cellulitis

Complications of Untreated Varicose Veins and Venous Insufficiency #2: Cellulitis

Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Cellulitis infections can occur in the legs of people with untreated varicose veins and chronic venous insufficiency.  The reason for this is chronic venous insufficiency causes inflammation within the skin and underlying tissues. This inflammatory process causes the skin to become firm, eczema like, dry, itchy and fragile. Healthy skin acts like a barrier to bacteria, preventing infections. But, in chronic venous insufficiency, the skin is fragile and this barrier is susceptible to bacterial infections, that can enter the tissues through cracks or breakages within the skin.  In chronic venous insufficiency, the skin around the ankles is most affected and infections can begin here.

Cellulitis usually begins as a small area of pain and redness on the skin. This area spreads to surrounding tissues, resulting in the typical signs of inflammation such as redness, swelling, warmth, and pain.  Fever and chills may develop and the redness will spread affecting more of the leg. It is treated with antibiotics. If you believe you have signs of cellulitis, you need to contact your doctor right away as untreated cellulitis can spread rapidly.

This complication can be avoided by treating the varicose veins and eliminating underlying venous insufficiency, which will in turn reduce inflammation and improve the skin condition.  Practicing good skin hygiene is important. Keep your skin moisturized so that it doesn’t flake or crack easily. If the skin is not broken or leaking fluid but is inflamed, your doctor may recommend an anti-itch cream, such as one containing hydrocortisone; a cream containing zinc oxide to protect the skin; or an antifungal cream to prevent fungal infections.

Skin that is leaking fluid is treated with wet compresses. If you have ulcers on your legs, your doctor will show you how to apply layered compression bandages to protect the skin and maintain blood flow.

 

Results of Non-Surgical Vein Treatment

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Before and After Picture of Non-surgical Removal of Varicose Veins at La Jolla Vein Care. The before picture shows bulging varicose veins that arise from an incompetent great saphenous vein (this vein is not visible to the naked eye). In the past, these veins would have been stripped with vein stripping surgery. Fortunately, new technology allows for even large varicose veins to be removed without surgery. This patient underwent radiofrequency ablation (or endovenous ablation) of the great saphenous vein and foam sclerotherapy of the bulging varicose veins at La Jolla Vein Care.

 

Complications of Untreated Varicose Veins #1: Phlebitis

What Possible Complications Can Occur From Untreated Varicose Veins?

Over time, complications can develop from untreated veins. These include:

  • Superficial phlebitis

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    A superficial thrombophlebitis (also known as STP) refers to a blood clot that has formed within the vein causing it to become painful and inflamed. The overlying skin becomes red, hot and painful to touch. The blood clot forms as a complication of varicose veins, because the blood is not circulating well in varicose veins.

  • Skin discoloration and eczema around the ankle
  • Skin sores or ulcers usually near the ankle
  • Burst or hemorrhaged vein
  • Chronic venous insufficiency
  • Infection of the skin, or cellulitis

This blog post will discuss phlebitis. Phlebitis refers to the painful swelling and inflammation within a vein, usually a varicose vein.  A thrombophlebitis is swelling and inflammation of a vein caused by a blood clot. A phlebitis is common with varicose veins, and thrombophlebitis less common but still a potential complication from untreated varicose veins.  A thrombophlebitis refers to a blood clot that has formed within the vein causing it to become painful and inflamed. The overlying skin becomes red, hot and painful to touch.

The blood clot forms because the blood is not circulating well in varicose veins. The blood is stagnant in varicose veins and is more likely to form clots. When blood clots are formed within varicose veins, this is called a superficial thrombophlebitis (since varicose veins sit near the skin surface).  This is often referred to as an STP.

The following symptoms are often associated with thrombophlebitis:

  • Inflammation (swelling) in the part of the body affected
  • Pain in the part of the body affected
  • skin redness (not always present)
  • Warmth and tenderness over the vein

Thrombophlebitis of varicose veins can be avoided by wearing compression stockings daily (prevents pooling of blood), leg elevation, staying active and treating the varicose veins.  If you think you have phlebitis, you should see a doctor. An ultrasound examination is may be necessary.

Before and After: Varicose Veins

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Before and After Photo: This is a before and after picture of varicose veins that were removed without surgery at La Jolla Vein Care. Modern varicose vein treatments no longer require surgical removal. Please see our photo gallery for more before and after pictures (‘Results’ page) of varicose veins at http://lajollaveincare.com/results/ or click on the ‘Treatments’ page to learn more about our treatments.

Before and After Photo: This is a before and after picture of varicose veins that were removed without surgery at La Jolla Vein Care. Modern varicose vein treatments no longer require surgical removal. Please see our photo gallery for more before and after pictures of varicose veins, spider veins and venous leg ulcers on our ‘Results’ page  or click on the ‘Treatments’ page to learn more about our treatments.

Changing Insurance Requirements for Varicose Vein Treatment

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Compression stockings and socks are an important part of the regimen for the treatment of varicose veins. Insurance will require that they are used for 6-12 weeks prior to approving and paying for varicose vein treatment. The good news is that compression socks and stockings are available now in a wide variety of fashion styles and colors. Because new styles of compression socks are more fashion friendly, you can integrate medical therapy into your wardrobe for work and casual attire. Fashion compression can be found at compressrx.com.

We have noticed a trend over the past year regarding insurance coverage for varicose veins; Insurance is increasingly becoming stricter with their policies for varicose vein coverage. Insurance policies vary from person to person regarding whether or not their policy will cover the actual vein treatment (office visits, diagnostic ultrasound examinations, and consultations are typically covered benefits by most).  Most insurance types now require that an individual has worn and tried medical grade compression for over 3 months before they can be considered for varicose vein treatment. Specifically, the patient has to have been using medical grade compression for 3-months or longer and still has not had improvement in symptoms.  The exceptions are Medicare and Anthem require only a six week trial of compression. Compression socks and stockings are part of conservative management for vein conditions.  Medical grade compression socks are stronger than over the counter socks and may require a prescription. Because your insurance may require 3 months of wearing compression socks/stockings before they will pay for your medical vein procedure, you should start wearing them as soon as possible and document it. For example, ask your primary care physician for a prescription. Keep your receipts for the purchase, as sometimes insurance requires proof of when you started using compression. Insurance usually does not cover compression stockings but flexible health savings account can typically be used. Compression stockings should be used as a trial of conservative treatment in addition to leg elevation, exercise, weight loss and NSAIDS. We are happy to answer questions about insurance coverage for vein procedures. Please call us at 858-550-0330.

Dr. Fronek Featured in National Vein Magazine

Past ACP President and La Jolla Vein Care’s Dr. Helane Fronek, MD, FACPh, FACP was featured in this summer’s Vein Magazine. The 5-page interview with Dr. Fronek discusses topics such as her career and perspectives in the fields of venous disease and medicine. She is described as:

‘Professionally, Dr. Froenk sees patients at La Jolla Vein Care, educates medical students as an assistant clinical professor at the UC San Diego School of Medicien, is the author of the Fundamentals of Phlebology, is a past President of the American College of Phlebology (ACP), is the first recipient of the ACP’s Leadership Award and is recognized as an Honorary Memeber of the organization……..she is also a blogger on The Huffington Post and has recently added Life Coach to her distinguished resume…’

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Past ACP President and La Jolla Vein Care’s Dr. Helane Fronek, MD, FACPh, FACP was featured in this summer’s Vein Magazine. The 5-page interview with Dr. Fronek discusses topics such as her career and perspectives in the fields of venous disease and medicine.

Dr. Fronek

Dr. Helane Fronek, MD, FACPh, FACP is a Past ACP President, author of the Fundamentals of Phlebology, Assistant Clinical Professor at UCSD School of Medicine and presently sees patients at La Jolla Vein Care, located at the Scripps Memorial Campus.

La Jolla Vein Care is grateful to have such a talented doctor on our staff. You can read Dr. Fronek’s blog  at helanefronekmd.wordpress.com.