WHAT IS PERIPHERAL VENOUS DISEASE? | DISEASES | TESTS AND PROCEDURES | NONSURGICAL TREATMENT | SURGICAL TREATMENT

What is peripheral venous disease? 
Peripheral venous disease is a general term for damage, defects, or blockage in the peripheral veins. These veins carry blood from the hands and feet to the heart to receive oxygen. Peripheral venous disease can occur almost anywhere in the body but is most common in the arms and legs. Varicose veins and chronic venous insufficiency are two of the most common peripheral venous diseases.

What causes peripheral venous disease?
The most common cause of peripheral venous disease is a blood clot that blocks a vein. When the clot is in a vein deep within the body, it is called a deep venous thrombosis. When the clot is in a vein closer to the skin, it is called superficial venous thrombophlebitis.

What causes blood clots?
A blood clot forms in the vein when the walls of the vein become weak and blood flows slowly through the vein. The walls can become weak through an injury, a long period of bed rest or inactivity, major surgery, pregnancy, or being overweight. Smoking, some cancers, and the use of birth control pills may also cause walls of the vein to become weak.

What are the symptoms of peripheral venous disease?
The most common symptom of peripheral venous disease is pain where the blood clot is located. You may also feel a warm area or notice an area of redness or swelling over the affected vein.

How is it diagnosed?
Peripheral venous disease is diagnosed through a physical examination that includes a check of your blood pressure and your heart. Your doctor can usually tell if you have a blood clot. However, you may have to undergo some additional tests. Common tests include Doppler ultrasound imaging, a venography, and a VQ scan.

How is peripheral venous disease treated?
In some cases, peripheral venous disease clears up by itself. In other cases, home treatment can help ease the condition. You may have to exercise, bandage, or elevate the affected area or wear special compression stockings. These elastic stockings squeeze the veins and keep the blood flowing in your legs, which makes it more difficult for blood clots to form. It might take several weeks or months before you notice improvement. 

There are treatments for peripheral venous disease that do not require surgery. Coumadin therapy, angiosplasty and stenting, and sclerotherapy are three common and safe nonsurgical treatments.

In cases where the blood clot is deep in the vein, you may have to undergo surgery. A widespread and safe common surgical treatment is called vein stripping. Your doctor will recommend the best treatment for your particular condition.

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DISEASES

Chronic Venous Insufficiency

What is chronic venous insufficiency?
Chronic venous insufficiency (CVI) is a condition in which blood in the veins of the legs does not drain properly. The blood does not return to the heart as it should. The condition usually involves one or more veins in the legs.

What causes it?
CVI is caused by damaged valves in your veins. These one-way valves keep the blood flowing toward the heart. When the valves do not work properly, blood pools in the legs and feet. CVI is also caused by abnormal blood vessels in the legs that prevent normal circulation; veins previously damaged by blood clots; an injury to the leg; and certain cancers in the pelvis or abdomen region that prevent blood flow out of the legs.

What are the symptoms of chronic venous insufficiency?
The most common symptom is swelling of the leg, usually around the ankle. You may also experience cramping, heaviness, or a dull aching in the leg, especially after standing for a long period of time. Over time, the skin on the affected leg may itch and turn a brownish-red color. The skin may also become thin and tear easy, or it may become thick and hard. People who suffer from chronic venous insufficiency experience many of the symptoms of varicose veins.

How is it diagnosed?
Through an examination and a look at your medical history, your doctor will be able to determine if you have CVI. Your doctor may order Doppler ultrasound imaging or other tests to determine if there is any blockage in the veins of your legs.

How is CVI treated?
If your doctor tells you have CVI, you can begin home treatment by elevating the legs to help the pooled blood drain properly. Your legs should be above the level of your heart. You should also avoid long periods of standing or sitting. If you must sit for a long period, stretch and flex your legs every 5 minutes or so to keep the blood flowing in your veins. Your doctor may recommend that you wear compression stockings. These elastic stockings squeeze the veins and keep the blood flowing in your legs, which makes it more difficult for blood clots to form.

If the skin is inflamed, your doctor may recommend wet compresses or the application of an anti-itch ointment. If the skin is infected, your doctor may recommend an antifungal cream or antibiotics. If varicose veins are a problem, they may have to be removed.

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Thrombophlebitis

What is thrombophlebitis?
Thrombophlebitis is the occurrence of a blood clot and inflammation in a vein in your legs. When the vein is near the surface of your skin, it is called superficial thrombophlebitis. When the vein is deep within the body, it is called deep vein thrombosis. Sometimes the inflammation occurs in a vein in the arms, but this is rare. 

What causes thrombophlebitis?
Thrombophlebitis is caused by long periods of inactivity such as lying in a bed after surgery or sitting for a long time in a car or airplane. This inactivity decreases the blood flow through your veins and may cause a blood clot to form. Other causes may include paralysis and certain types of cancer.

What are the symptoms?
The most common symptom of a problem with a vein near the surface is tenderness or pain over the affected area. A hard red cord may appear just under the surface of the skin. Sometimes, but not always, inflammation or redness of the skin may occur. 

When the problem is in a vein deeper within the body, your leg may become painful and swollen, particularly when you walk or stand. Some people also have a fever. But often there are no symptoms to warn you of deep vein thrombosis.

How is it diagnosed?
Through an examination that includes checks of your pulse, blood pressure, and circulation, your doctor will be able to determine if you have thrombophlebitis. Your doctor may order Doppler ultrasound imaging or other tests to determine if there is any blockage in deeper veins in your legs.

How is it treated?
Superficial thrombophlebitis is treated by resting and elevating the affected leg; wearing compression stockings, which help prevent clots; and taking medications called anticoagulants, or blood thinners, to prevent blood from clotting. One such medication is Coumadin. With these types of home treatment, the condition usually clears up in several weeks.

If the vein is narrowed or damaged, a nonsurgical treatment called angioplasty and stenting, may be called for. 

Surgery is rarely needed to treat thrombophlebitis. For rare extreme cases, a surgical technique called vein stripping is used to remove the diseased part of the vein.

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Varicose Veins

What are varicose veins?
Varicose veins are twisted, swollen blood vessels near the surface of the skin. Any vein may become varicose, but veins in the legs and ankles are the ones most commonly affected.

Varicose veins are common, especially in older women. They are more likely to occur in women than in men. In most cases, varicose veins are not a serious medical condition. In some cases, however, varicose veins may be a sign of a blockage in veins deeper in the body. This condition, called deep vein thrombosis, is more serious and requires evaluation by your doctor.

Spider veins, a mild variation of varicose veins, are also common and more of a cosmetic than a medical problem.

What causes varicose veins?
Varicose veins develop when you have defective valves in your veins. These one-way valves keep the blood flowing toward your heart. When the valves do not work properly, blood pools, pressure builds, and the veins become twisted, swollen, and weakened. 

Varicose veins may also develop from increased pressure on the leg veins caused by standing for long periods of time or being overweight or pregnant. Normal aging, hormonal changes, and genetics (family history) may also contribute to varicose veins.

What are the symptoms?
Common symptoms of varicose veins include tired and achy legs. Your legs may also have a heavy feeling. However, these symptoms are not always present. Sometimes there may be just the appearance of dark blue, swollen veins through the skin. The skin may also feel dry and thinned. There may also be inflammation or open sores. 

How are varicose veins diagnosed?
Your doctor will examine your legs and feet. Varicose veins are easy to spot.

How are they treated?
Varicose veins will not get better unless they are treated. Traditional home treatment includes resting, elevating the leg, and wearing compression stockings, elastic stockings that squeeze the veins and keep the blood flowing in your legs.

In some cases, a procedure called sclerotherapy is used. The procedure is done in your doctor’s office without anesthesia.

Treatments for varicose veins and spider veins are simple and highly successful. But, in some people, varicose veins may develop again.

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TESTS AND PROCEDURES

Doppler Ultrasound Imaging

What is Doppler ultrasound imaging?
Doppler ultrasound imaging is a simple test done in the lab to see if there is any blockage in your blood veins. The procedure is used on the arms or neck, but most often on the legs.

How does it work?
A technologist spreads a warm non-greasy lotion on the area to be examined and then runs a small hand-held instrument called a transducer over the area. The transducer probes the vein and collects data needed to form an ultrasound image. An ultrasound image (also called an sonogram) is made with sound waves. The sound waves travel through your body and are picked up by a computer and displayed on a computer screen. Later these images are transferred to film or video for examination by your doctor. The image will show the flow of blood through your veins. The procedure takes about 15 to 30 minutes.

Is Doppler ultrasound imaging safe?
The test is perfectly safe and painless. No dyes are injected into the body, and no needles or tubes are used. You will not be exposed to radiation. The lotion spread on your skin does not harm the skin or clothing. 

How do I prepare for the procedure?
The test requires no special preparation on your part. But be sure to let your doctor know if you have any allergies, which medications you are taking, or if you are pregnant.

What happens after the procedure?
After the procedure, the technologist removes the ointment, and you can resume your normal activities. Your doctor will review the images and any other test results. If the veins are blocked, your doctor will then recommend the appropriate treatment.

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Venography

What is venography?
Venography (also called phlebography) is a simple test that shows the site of any blood clots or unusual blockage or narrowing in the veins of the arms or legs. A technician takes an X-ray, called a venogram, of your veins.

How does it work?
Using a narrow, flexible tube called a catheter, the technician injects a dye into the veins of your arm or leg. The dye travels through your veins making them easier to see in the X-ray. You will be given a local anesthesia. You may ask for a sedative if you are nervous about the test. The whole procedure takes about two hours. 

Is it safe?
Venography is a very common test. Both the X-ray and the dye are safe. The exposure to radiation is low. You may feel a burning sensation when the dye is injected. There is a slight chance you may react to the dye. 

How do I prepare for the procedure?
The test requires no special preparation on your part. But be sure to let your doctor know if you have any allergies, which medications you are taking, or if you are pregnant.

What happens after the procedure?
After the test, you may feel tenderness or soreness at the site where the catheter was inserted. You should be able to resume your normal activities immediately after the test. Let your doctor or the X-ray technician know if you are experiencing any pain or unusual symptoms.

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VQ scan

What is a VQ scan?
A VQ scan is test used to detect a pulmonary embolus, a blood clot in the lungs. A blood clot in the lungs lowers oxygen levels, which causes shortness of breath. A blood clot in the lungs can be fatal. The test is done in the  Nuclear Medicine Department. 

How does the test work?
You lie flat on a table for about an hour while a special camera takes a number of pictures of your chest from different angles. Using a thin, flexible tube called a catheter, the technician will inject a slightly radioactive solution into a vein in your arm or leg. The technician will also ask you to breath through a tube that contains a mixture of air, oxygen, and a gas called xenon, which is slightly radioactive. The special camera detects the radioactive materials, which help measure oxygen in the blood and airflow in the lungs.

Is a VQ scan safe?
The test is perfectly safe and painless. The radioactivity you will be exposed to is too small to cause any complications or side effects. You may feel slight discomfort at the site in your or arm or leg where the catheter is inserted. Pregnant women should not go through this test.

How do I prepare for the test?
The test requires no special preparation on your part. But be sure to let your doctor know if you have any allergies, which medications you are taking, or if you are pregnant.

What happens after the test?
Immediately after the test, you can resume your normal activities.

Because the test is done when you are suspected of having a pulmonary embolus, which is a serious condition, the results of the test will be available within a few hours. From the pictures taken during the test, your doctor can determine the probability of your having a blood clot in your lungs.

If the probability is low, your doctor may do nothing but make an appointment to examine you again in a short while. If the probability is higher, your doctor will prescribe blood-thinning medication. If the probability is high, your doctor will order additional tests that will more clearly determine if you indeed have a blood clot.

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NONSURGICAL TREATMENT

Angioplasty and Stenting

What is angioplasty and stenting?
Angioplasty and stenting is a procedure to unblock a blood vessel (vein or artery) to increase blood flow through that vessel. It is less invasive than surgery and you recover much quicker. 

How does it work?
The vascular surgeon or interventional radiologist makes a small cut in a vein in your arm or groin area. Then, using X-rays for guidance, the surgeon threads a narrow, flexible tube called a catheter through the vein into the blocked vein. Through the catheter, the physician passes a small mesh tube called a stent. A tiny balloon is placed inside the stent and inflated. The pressure from the inflated balloon opens the stent and sets it in the vein. The balloon is then deflated and removed while the stent settles in the vein to keep the vein open and the blood flowing. 

Is it safe?
Angioplasty and stenting is a common and safe procedure. It is best known as a treatment for heart problems, but is also used to open up blocked or clotted veins. As with any medical procedure, there is a chance of complications. Complications include tearing of the vein wall, bleeding at the site where the catheter is inserted, and allergic reaction to the dye used with the X-ray. People with kidney disease or diabetes may have a higher risk of complications from the dye. 

How should I prepare for angioplasty and stenting?
Before the procedure, you may undergo several tests, including X-rays and blood tests. Be sure to tell your doctor what medications you are taking and whether you have any allergies.

You should not eat or drink anything after midnight on the day of your procedure. Ask your doctor if you should take any of your regular medications, especially if you are taking any blood thinners such as Coumadin. 

You should plan to stay overnight in the hospital and arrange for someone to drive you home the next day.

What happens after the procedure?
After angioplasty and stenting, you will be moved to a recovery room. A nurse will monitor your heart and blood pressure and check the site where the catheter was inserted for bleeding. You may have a large pressure bandage to prevent bleeding. You will be instructed to keep your leg straight for several hours if the catheter was inserted at your groin. After resting in bed for 12 to 24 hours, you can begin walking. 

Tell you physician or nurse immediately if you notice any complications or symptoms. Occasionally people experience pain in the leg; pain, numbness, or bleeding around the site where the catheter was inserted; shortness of breath; fever; or a leg that feels cold and turns blue.

When you return home, you should drink plenty of water for 2 days to help flush out the dye used for the X-ray. You should be able to resume moderate exercise and driving after several days. You will take aspirin or other medications for a long time after angioplasty and stenting to help prevent the formation of blood clots in your stent. Your doctor will schedule a time to see you after the procedure. 

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Sclerotherapy

What is sclerotherapy?
Sclerotherapy is a procedure to treat varicose veins. The procedure can be done in your doctor’s office without anesthesia. It usually takes 5 to 30 minutes, depending on how many veins are affected. You can usually assume your normal activities a day or two after the procedure. Sclerotherapy may be covered by your health insurance if it is done for medical, not cosmetic, reasons.

How does it work?
A thin, flexible tube called a catheter is inserted into the veins. Through the tube, the doctor injects a chemical substance called a sclerosant that causes the veins to close and scar over. This forces the blood to reroute itself and flow through healthier nearby veins. 

Is sclerotherapy safe?
Sclerotherapy is a common and safe procedure. You may feel burning or cramping from the shot for a few minutes. You may feel itching or slight pain where the veins were treated. There may also be some blistering, bruising, or scarring of the skin. 

The most common side effect is a change in the color of the skin above the treated vein. The change in color may take up to 12 months to disappear. In some people, the change may be permanent. 

Some people may have a reaction to the sclerosant. A severe reaction is very rare, but it can be life threatening. 

Sclerotherapy is highly effective in treating varicose veins. However, in some people, the varicose veins may recur.

You should not undergo sclerotherapy if you have blood clots in the veins deep in your legs [(thrombophlebitis)], are pregnant or nursing, or have a history of allergy to sclerosant or similar substances.

What happens after the treatment?
After treatment, you should be able to walk immediately. However, your doctor will probably recommend that you avoid strenuous exercise for several days. You may need to wear elastic bandages or compression stockings for several days or weeks after the procedure to keep pressure on the veins and prevent the blood from returning to the treated veins.

Depending on how many veins are affected and the type of sclerosant used, you may have to go to the doctor for the procedure more than once.

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Coumadin Therapy

What is Coumadin therapy?
Coumadin is the brand name of a medication used to prevent and treat [thrombophlebitis] and other problems caused by blood clots. You take the medication orally. The medicine in Coumadin is called warfarin sodium. It is known as an anticoagulant, or blood thinner, because it reduces the blood’s ability to form clots. 

How does it work?
Coumadin and other blood thinners prevent new bloods clots from forming and stop existing clots from growing. They do not dissolve existing blood clots.

Is it safe?
At the correct dosage, Coumadin is perfectly safe. If the dosage is too high, there may be bleeding. You should watch for unusual bruises, blood in the urine or in the stool, bleeding gums, excessive menstrual flow, nosebleed, or other unusual bleeding that does not stop. Call your doctor or take yourself to an emergency room immediately if you have bleeding that does not stop when you apply pressure.

For some people, during the first few days of treatment with Coumadin, a blue or purple skin rash may develop because the drug affects circulation. But this is rare. Some people will have nausea or stomach cramps from Coumadin. Ask your doctor or pharmacists about side effects for this and all other medications.

Pregnant women and people with active stomach ulcers or severe liver or kidney disease should not take blood thinners.

How soon will I notice results?
The medication may take several days to take effect. When you begin Coumadin therapy, you will have to have your blood tested several times a week to check the effects and correct the dosage. Later, you will need a blood test at least once a month. You will usually receive the results of your blood tests the same day.

Will other drugs I take affect the Coumadin?
Certain common drugs do affect Coumadin. You should avoid aspirin, ibuprofen, certain seizure medications, birth control pills, antacids, antihistamines, some antibiotics, and alcohol, if possible, when taking Coumadin. Be sure to tell your doctor about all the drugs you are taking before beginning your Coumadin therapy.

Will I have to change my diet?
Diet does affect Coumadin and other blood thinners. Vitamin K, for instance, reverses their effects. Foods high in vitamin K include beef, pork, and chicken livers; soy protein products, including tofu; green leafy vegetables such as kale, spinach, and collard, turnip, and mustard greens; vegetables in the cole family such as broccoli, cauliflower, and Brussels sprouts; and some vegetable oils, including canola oil. 

Will I have to change my lifestyle with Coumadin therapy?
You should avoid activities and sports where there is a risk of injury or falling that may cause bleeding. Talk with your doctor about safe activities. You will also have to schedule regular blood tests while on Coumadin therapy. And plan to take the medication at the same time every day. 

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SURGICAL TREATMENT

Vein Stripping

What is vein stripping?
Vein stripping is a surgical procedure used to treat or remove varicose veins. Vein stripping is generally done on large varicose veins. 

How is the surgery done?
You will be placed under a general anesthesia and will be unconscious and feel no pain during the operation. The surgeon will make incisions at your groin (the top of the vein) and near your ankle (the bottom of the vein). Then the surgeon will insert a thin, flexible instrument into the vein and strip the vein from the inside. Stripping removes the diseased part of the vein. The vein may be stripped or removed entirely.

Is vein stripping safe?
Vein stripping has the same risks as any other general surgery: the possibility of infection, bleeding, and reaction to anesthesia. But overall, vein stripping is a proven and safe surgical procedure. Even the loss of a few veins is no problem for most people. When veins are surgically removed, remaining veins deeper in the body adapt by stretching so they can hold larger volumes of blood. The normal flow of blood continues. In some people, varicose veins do return, which may require additional surgeries.

Who will perform the surgery?
The surgery will be performed by a team of professionals led by a vascular surgeon. Vascular surgeons specialize in the treatment and care of blood vessels.

What do I have to do to prepare?
Vein stripping is usually done on an outpatient basis, so you do not have to prepare for a stay in the hospital. But you should arrange for someone to take you home after your surgery. You should not eat or drink anything six hours before the surgery. Let your doctor know if you have any allergies, which medications you are taking, or if you are pregnant. 

What can I expect after the surgery?
Unless complications arise (they are rare), you will be able to go home the same day of the surgery. Your leg will be tightly wrapped in a bandage. When you get home, you will need to keep your feet raised above your heart as much as possible. You should be able to walk the next day. In fact, your doctor will probably recommend it. Walking will help keep the swelling down and lessen the risk of problems in veins deeper in the leg. You should be able to return to work within several days and resume all normal activities within several weeks.

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