Vein valves play a critical role in helping blood flow through the veins back to the heart. Like swinging doors, valves open to allow blood to flow toward the heart and flap closed again to prevent the flow of blood back down the legs. If the veins become dilated, the flap-like valves cannot completely close, making them incapable of preventing the back flow of blood. This ‘back flow’ of blood through dysfunctional valves is called venous reflux or venous insufficiency.
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.
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.’
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.
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 website.
Leg cramps occurring at night (nocturnal leg cramps) are a common symptom of venous disease. In fact, in the San Diego Population Study, leg cramps were the second most common symptom in people with venous disease with a prevalence of 14.3%. Leg aching (17.7%) was the most common complaint and tired and swollen legs were also predominant symptoms.
Healthy veins collect the de-oxygenated blood from the tissues. The venous blood, which is low in oxygen and high in waste products is returned to the heart and lungs where it is replenished with oxygen and nutrients. In diseased veins, the blood circulates poorly, allowing blood to pool and become stagnant. The exact mechanism that causes cramping in the legs is uncertain. But, when the cramping is caused by the poorly functioning veins, the symptoms are often alleviated by correcting the underlying problem. Conservative measures, such as elevating the legs, walking regularly, and wearing compression therapy may reduce the frequency of night cramps. Treating the underlying venous insufficiency may be curative.
There are many causes for leg cramps and if you suffer from night cramps it is important to be properly evaluated to determine the cause. Cramps that occur with exercise are more likely to be associated with a more serious condition. If your muscles cramp with walking for a short time and recover with rest this may indicate arterial disease. Other causes for leg cramps include muscle injury, thyroid conditions, pregnancy, electrolyte imbalance, dehydration or other causes.
To help identify the cause, it may be helpful to keep a log of daily activities, or change in activities; for example, heavy exertion may indicate a muscular cause or long periods of standing or sitting may favor venous disease. A recent study showed that prolonged standing at work may be an important risk factor for varicose veins and nocturnal leg cramps.
Check with your primary care physician to rule out other causes for leg cramps. Blood tests can check for thyroid, kidney and electrolyte conditions. You may also have undiagnosed venous reflux.
At La Jolla Vein Care, our vascular imaging scanners help us detect vascular causes of leg pain. For example, we can utilize one of our three duplex ultrasound imaging systems to scan for blood clots in the leg veins (deep venous thrombosis), venous insufficiency and identify significant problems in the arterial circulation.
Call us for more information about our vascular imaging services 858-550-0330.
Vein procedures are generally a covered benefit by most insurance types (including Medicare) if they are considered medically necessary. Medical necessity requirements varies by the individual policy, but in general the varicose veins must cause symptoms such as leg pain, heaviness, fatigue, aching, restless legs, swelling or skin changes such as darkening of the skin around the ankles. Sometimes varicose veins can cause complications such as phlebitis, bleeding, ulceration or skin changes; these are considered medical conditions. If varicose veins do not cause symptoms, they are considered to be a cosmetic issue in the eyes of insurance.
An ultrasound examination is necessary to provide an overall assessment of the severity of the vein condition. This is a diagnostic study and usually covered by insurance.
In most cases, insurance companies require that conservative measures have been tried for several weeks. Conservative measures include compression stockings, leg elevation, exercise, weight loss or maintaining a healthy weight, NSAIDS or other medication and hot/cold packs. Many insurance types REQUIRE 6 to 12 weeks of wearing medical grade compression stockings prior to being approved for treatment.
Sometimes, flexible spending accounts can be used to pay for or may reimburse for compression stockings, varicose veins and spider vein treatments.
For more insurance information and questions, email firstname.lastname@example.org
We’re often asked, ‘Am I too old to treat my varicose veins?’ The answer is no. Since modern varicose vein treatments are largely non-surgical, there are appropriate treatment options for those of any age. While varicose veins are more common with each decade of life, they can appear on young teenagers or at any time in older adults. For active older adults, addressing varicose vein conditions is even more important to maintain healthy legs. Otherwise, symptoms of leg heaviness, fatigue, swelling and pain can slow you down. There are other complications of untreated varicose veins such as superficial thrombophlebitis, varicose vein rupture and leg ulceration, in severe cases. There are a variety of minimally invasive treatment options for varicose veins, and depending on the individual preference, severity of the condition and the veins affected will help you and your doctor determine the best treatment course.
Yesterday, the Emmy award-winning television show, Dr. Oz featured information about blood clots in the veins, specifically, deep venous thrombosis (DVT). He demonstrated how they can break off and travel to the heart and lungs. But, what was missing from this segment was more information about what causes DVT and how can you prevent them.
What are some of the most common causes of DVT?
DVT: There are many causes of DVT. You can categorize these into three main groups. (Medically, these 3 risk factors for DVT are collectively called Virchow’s Triad)
A) Decreased movement of blood (venous stasis),
- Decreased movement of blood can be caused by immobilization: sedentary, prolonged sitting, long plane flights or car trips, or post-surgery being inactive, and bed rest like in hospitals or nursing homes. This is where compression is crucial to preventing blood clots since the external compression increases the venous return back to the heart and reduces pooling. Venous insufficiency allows blood to pool.
B) Increased tendency to clot (hypercoagulability)
- Temporary conditions such as pregnancy, cancer and obesity cause the blood to become hypercoagulable. The use of oral contraceptives, estrogens hormone replacement, testosterone, increase the risk of blood clots.
- The likelihood of a blood clot during pregnancy is 5-20 for every 10,000 women.
- The likelihood of a blood clot post partum is 40-65 for every 10,000 women.
- Genetic conditions that are inherited can increase the risk of blood clots. For example, Factor V Leiden and antiphospholipid antibody. 5% of the population carry one copy of the Factor V Leiden mutation.
C) Damage to the blood vessel wall
- Trauma, injury to the leg, surgery
What can you do to prevent DVT?
Stay moving, avoid prolonged sitting. For example, when flying or traveling, the risk of DVT is 1% on a long haul flight (greater than 6 hours). To minimize this risk, you should wear compression stockings (which helps increase the blood flow in the legs), stay hydrated, avoid excessive alcohol, use the calf muscles- walk about the cabin and frequently pump the calf muscles by doing foot lifts.
During pregnancy, compression stockings should be worn and after pregnancy, when the risk of DVT is highest (the likelihood of a blood clot post partum is 40-65 for every 10,000 women).
Your doctor can recommend to you what type of compression socks to use. For more information about compression socks, go to compressrx.com.