What are Vein Valves?

healthy_and_diseased_valves

In healthy veins, the valves close after the blood flows towards the heart, preventing back flow.
When veins become dilated, the valves cannot close properly, allowing blood to flow back towards the ankle.

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.

Society for Vascular Medicine Meeting To Be Held in La Jolla

The Society for Vascular Medicine’s 25th Anniversary and Scientific Sessions 2014 are going to be held in La Jolla this week. La Jolla Vein Care’s Dr. Bunke was asked to speak on venous topics.  The keynote speaker will be Dr. Jonathan Woodson, MD, U.S. Department of Defense, Assistant Secretary of Defense (Health Affairs). There will be several scientific topics and research discussed over several.  Some of the topics include:

Venous disease

Lymphatic disease

Anticoagulants, thrombolytic therapy

PAD/endovascular therapy
Carotid arterial disease/endovascular therapy

Management of the non-healing wound in venous disease
Phlebectomy
Management of the diabetic wound
What do the guidelines recommend?

 Sclerotherapy, laser, endovenous approaches, liquid sclerotherapy
Foam sclerotherapy
Endovenous laser and instruction for access
Endovenous RF and instruction for access
Chronic Venous Disease
Epidemiology and pathophysiology including molecular insights into venous ulcer formation
Medical management: Compression therapy, novel herbal agents (horse chestnut and others)
Endovascular therapy: Ablation, radiofrequency, laser (superficial vs. deep incompetency)
Treatment of chronic venous occlusions svmlogo

How Do Varicose Veins Develop?

Varicose_veins

This image demonstrates how varicose veins develop.

Your veins have one-way valves that help keep blood flowing toward your heart. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell, which can lead to varicose veins.

Varicose Veins: Why Me?

Who gets varicose veins and why.

Both women and men can develop vein disorders at any age.  It can affect the healthiest of individuals, but there are some conditions that increase your risk of developing varicose veins.  They are mostly inherited; if both of your parents had varicose veins, you have a 90% chance of also having them.  Other factors that increase your chance of developing vein disorders include being female, hormonal changes, pregnancy, getting older, having a job that requires many hours standing or sitting, being overweight, and a history of leg injuries.

  • Increasing age. As you get older, the valves in your veins may weaken and not work as well.
  • Heredity. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have varicose veins have a family member who has them too.
  • Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
  • Pregnancy. The hormones during pregnancy greatly influence the leg veins. Varicose veins can even be a symptom of pregnancy and can show up during the first trimester. As pregnancy progresses, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus  also puts pressure on the veins. Varicose veins usually improve within 3 months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
  • Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
  • Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
  • Leg Injuries

    LJVC

    Varicose Veins: Before and After Treatment. These varicose veins were removed without traditional vein stripping surgery at La Jolla Vein Care. To read more about minimally invasive varicose veins treatments, go to www.lajollaveincare.com

How does graduated compression help with the management of varicose veins?

 

Graduated compression therapy is used to treat vein disorders such as varicose veins, venous leg ulcer, venous insufficiency, venous reflux disease, swelling and after vein treatments.  They work by applying external pressure to your legs reducing venous pressure. These elastic stockings squeeze or compress the veins and prevent blood from flowing backward. Compression stockings must be graduated, medical grade compression to be beneficial. Graduated compression stockings are great to use if your want to increase circulation, support you leg veins, and want to reduce uncomfortable leg symptoms such as swelling, tired and achy feeling legs.

graduated_compression_leg_1Over the counter support hose or TED hose are not adequate to reduce symptoms in venous disease for active patients. More questions about compression therapy can be answered at compressrx.com.

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.

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.

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.