7 Signs of Venous Disease

#1 A feeling of heaviness or fullness in the legs that gets worse as the day progresses.

#2 Leg fatigue and tiredness in the legs, that also becomes worse by the end of the day and after prolonged standing or sitting. Some patients describes their legs as being ‘full of energy’ in the morning but are tired by the evening. For example, after a long day at work, disney land or the grociery store, you may feel like you need to run to a chair to recline and elevate the legs.

#3 Leg swelling, mostly affecting the ankles. Your legs may be normal in the morning but you notice swelling or that your shoes are tight by the end of the day.

#4 Leg pain. This can occur generally, or along a varicose vein, especially those that run on the outside of the leg or behind the knees. Some patients report localized pain along the vein that feels like burning or throbbing. Leg pain that is worse during exercise may indicate a different problem.

#5 Night cramps. These are cramps usually in the calf or thighs that occur only at night.

#6 Restless Legs: a feeling of restlessness during the night, that may interrupt sleep. You may have to get out of bed to walk around and move your legs.

#7 Noticeable bulging, twisted veins called varicose veins

symptoms

Can Spider Veins Be Painful?

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Spider veins are small abnormally enlarged reddish or bluish vessels located at the surface of the skin. They can look like tree branches or spiderwebs with their short, jagged lines. They can be found on the legs and face and can cover either a very small or very large area of skin. Spider veins are like varicose veins but smaller. They can also can symptoms such as leg pain, itching, aching, burning and throbbing, just like larger veins.

In contrast to what most people think, spider veins are not only cosmetic but can actually cause symptoms, including swelling and heaviness of the legs. This may be in part because small spider veins can be a sign of underlying venous insufficiency or venous reflux disease.

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Why Didn’t My Spider Veins Go Away?

Before and After spider vein treatment at La Jolla Vein Care. This picture demonstrates that spider veins (reddish spider like vessels) can stem from underlying feeder vessels (the blue vein). The feeder vein can be compared to the ‘root’ of a weed; If you clip the surface branches of a weed without pulling the root of the problem, the weed will never go away.
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Veins in certain locations, like in the inner knee or inner thighs and inner ankles, often arise from underlying venous incompetence of a vein called the great saphenous vein that runs from the groin along the inner thigh to the ankle. If spider veins do not respond to treatment, it is important to have an ultrasound evaluation to determine if there is an underlying source of the problem.  Once the underlying problem is properly identified, it can be treated. 

Spider veins can be the ‘tip of the iceberg’ and represent a bigger problem, that is not visible to the naked eye. For example, as seen in the first image, spider veins can arise from blue ‘feeder’ veins, which must be treated for best results.

Spider veins can also stem from an underlying problem such as venous reflux in larger veins, such as the great saphenous vein. As demonstrated in the second picture, spider veins in the inner knee, inner ankle and inner thighs can originate from this vein. This can only be determined by ultrasound examination. It is important to have your vein evaluated by a trained specialist. Effective treatment depends on an accurate and thorough diagnosis.

Can Varicose Veins Cause Leg Ulcers?

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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.

What is the Relationship Between Leg Cramps and Venous Disease?

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.

Leg Cramps and Varicose Veins

Varicose Veins and underlying venous insufficiency are a common cause of night cramps, or leg cramps occurring at night. They most frequently affect the upper legs, causing cramping in the thigh but may cause calf cramping.

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.

Before and After Photos: Spider Vein Treatment

This patient recently asked us to post his ‘before and after’ photos of his spider veins on the inner ankle (medial malleolus) following treatment here at La Jolla Vein Care.  He is a 62 year-old gentleman whose wife found the appearance of these unsightly veins a nuisance and they also caused itching. As a result, he wanted them to ‘disappear’ before summer. Four weeks after his second treatment session,  (8 weeks total) most of these diseased blue and red dilated vessels had disappeared.  He was treated with two sessions of liquid sclerotherapy using Asclera pharmaceutical grade solution. He wore his compression stockings the entire 8 weeks.

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Before and after spider vein photos at la jolla vein care.

Sclerotherapy is used to treat the small spider veins on the legs. Only a trained physician or RN/PA should administer sclerotherapy injections. Sclerotherapy usually requires more than one treatment session for best results and may take several weeks to see optimal results. The national average is 3-5 treatment sessions. A different type of sclerotherapy, called foam sclerotherapy is used to treat larger blue, reticular veins and varicose veins. This should be done under ultrasound guidance and is performed by a Medical Doctor. Read more about sclerotherapy and ultrasound-guided foam sclerotherapy at La Jolla Vein Care.com  or click here to see more La Jolla Vein Care’s before and after photos.

Am I Too Old? Varicose Vein Treatment at Any Age

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.

This is a 90 year-old female who wanted her varicose veins treated because they were bothersome to her when she played tennis and she didn’t like the way they look. These varicose veins were treated with painless injections, given at two treatment sessions. This is called foam sclerotherapy treatment of varicose veins.
The after picture is at one month following the varicose vein injections (foam sclerotherapy). She tolerated the treatment well and she was able to return to normal activities right away, with the main restriction being wearing compression stockings for several weeks.

 

What is a Venous Insufficiency / Duplex Ultrasound Test?

 

The Duplex Ultrasound examination, also called a venous insufficiency study allows us to visualize the blood vessels that are not visible to the naked eye, even blood vessels that are deep within the muscles.  The ultrasound examination is used to both identify the veins that have faulty valves and to map the anatomy of the veins, creating a ‘road map.’  This is necessary to make an accurate assessment of the cause and extent of the varicose veins, as well as to formulate the best treatment plan.  This should be done for any individual being evaluated for varicose veins, leg swelling, patients who have failed prior treatment, patients who are symptomatic and in some patients with certain anatomic patterns of spider veins.

Duplex ultrasound uses sound waves to get images of your blood vessels.  It also helps determine how fast blood moves through the vessels.

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One of our vascular sonographers, evaluating the great saphenous vein in the thigh with duplex ultrasound.

At La Jolla Vein Care, the venous duplex study will be performed by one of our registered vascular technologists, who have specialized training in the science of vascular sonography (RVT). It is performed in the standing position, which is important in obtaining an accurate study result.  This examination takes approximately 45-60 minutes. Following the study, the doctor will personally discuss the results with our patients to ensure a complete understanding of the ultrasound findings.  Insurance typically covers this type of diagnostic study.

 

Dr. Fronek teaches primary care doctors to care for patients with vein problems

Dr. Fronek was recently invited to discuss vein disorders with the Family Medicine Residency Program at Scripps Chula Vista.  The doctors-in-training were excited  to learn about the variety of problems that patients have with their veins – including  spider veins,  varicose veins,  blood clots, and leg ulcers.  Primary care doctors see patients with vein disorders every day, and yet very few medical schools or residency training programs include any information about these common problems.  Dr. Fronek and Dr. Bunke-Pacquette are committed to sharing their expertise with colleagues and are frequently asked to speak at medical meetings.  Primary care doctors, in particular, can often start patients with vein disorders on conservative treatment, including graduated compression stockings and regular exercise (walking is usually the best exercise for vein disorders), as well as certain supplements such as horse chestnut seed extract, that can alleviate the symptoms that many patients with vein disease suffer from.  Informed primary care doctors can also refer patients to a vein specialist when symptoms aren’t diminished with conservative treatment, if the varicose veins worsen while a patient is using compression and exercise, or if the patient suffers from a venous leg ulcer.

Oxford University Press releases The Vein Book

The second edition of The Vein Book, edited by Dr. Nisha Bunke Paquette and Dr. John Bergan will be released on January 30th, 2014 by the Oxford University Press.

Since its initial publication nearly a decade ago, The Vein Book continues to serves as the ultimate comprehensive resource on venous disease. Upholding its reputation as the go-to reference for complete, authoritative, and up-to-date information about venous function and dysfunction, this second edition effectively bridges the gap between clinical medicine and basic science, suitable both for the seasoned surgeon as well as the medical student.

La Jolla Vein Care's Dr. Bunke releases The Vein Book

La Jolla Vein Care’s Dr. Bunke releases The Vein Book

The book is divided into five essential sections: basic considerations, primary superficial venous insufficiency, venous thromboembolism, chronic venous insufficiency, and congenital venous malformations. The book covers the entire spectrum of venous conditions from clarification of the pathophysiology of venous insufficiency, molecular mechanisms in the cause of varicose veins, new treatment options for varicose veins and spider veins, startling new treatment for venous thromboembolic disease, and effective treatment for leg ulcers.

More user-friendly and encyclopedic than ever, The Vein Book is still a must-have for vascular surgeons, phlebologists, interventional radiologists, research scientists, epidemiologists, and surgeons at all levels.  It is available for pre-order at Amazon.com.