Capitol Vein Blog

Tuesday, August 16, 2016

Blood Clot Risk With Varicose Veins

I saw an interesting patient yesterday who came to the office complaining of two weeks of a progressively painful left leg. She has a many year history of mildly painful varicose veins and was discouraged to undergo varicose vein treatment by her family doctor who did not realize the potential risks that patients with varicose veins face. Varicose veins clearly present a medical problem and treatment is recognized as medically necessary by insurance payers.

By the time the patient saw me, she had a painful, swollen leg and tender hard varicose veins. Clearly, she had a superficial phlebitis of these large varicosities, but her venous duplex scan unexpectedly showed an extensive DVT that began as phlebitis in the varicose veins. This life threatening complication is a known risk factor complicating even mild to moderate varicose veins. I started her on Xarelto immediately and she will have a long course of blood thinners with potential long term effects of the blood clot.

It's important to understand that varicose veins involve disordered and turbulent blood flow that encourages clot formation. Commonly large surface varicose vein symptoms include leg pain, heaviness, fatigue, throbbing and even restless leg syndrome. However, both phlebitis and DVT are know complications that we hope to avoid by early treatment of varicose veins.

Saphenous vein reflux is the typical cause of varicose veins, and this is effectively and easily treated with VNUS Closure as well as VenaSeal and Clarivein, all of which are office based procedures performed under local anesthesia with immediate return to normal activity.

Patients should remain aware that varicose veins represent abnormal circulation in the leg, and treatment is very successful at preserving good leg health, a critical factor in maintaining a healthy lifestyle.

Sunday, August 14, 2016

Learn How to Increase Awareness of Blood Clots

Blood clots are a critical health problem for the population at large as the incidence of DVT and phlebitis has been increasing. The National Blood Clot Alliance (NBCA) and the Centers for Disease Control and Prevention (CDC) have kicked off the next phase of their widely acclaimed Stop the Clot, Spread the Word™ campaign, with an important focus on blood clot risk reduction among hospitalized patients.

Nearly 900,000 people Americans are affected by blood clots each year. About half of these blood clots occur during a hospital stay, or within 90 days of an inpatient hospital admission or surgical procedure, with many diagnosed after discharge. This is why patients should be aware of leg pain or swelling when they are home recovering. About 100,000 people die due to blood clots each year, which is greater than the annual number of deaths in the U.S. due to AIDS, breast cancer, and motor vehicle crashes combined!

Of course, anyone can develop blood clots, but people who are currently or recently hospitalized, recovering from surgery, or receiving cancer treatment are at increased risk. Patients with a family history of blood clots are also at increased risk as there may be a genetic predisposition to thrombus formation. Factor V Leyden is a common genetic defect that increases the clot risk. Patients with varicose veins are also at increased risk for clot formation as the flow in these enlarged twisted veins is abnormal.

Fortunately, the diagnosis of  a venous blood clot is rather simply done with a venous ultrasound exam that painlessly examines the flow. If a deep vein blood clot (DVT) is identified, we can start oral blood thinners that work immediately to reduce the chance of that clot moving to the heart or lungs. 

Reducing your risk of blood clots is critically important and eliminating the risk posed by varicose veins is easily done using office based procedures. For example, if saphenous vein reflux is seen on a venous duplex scan, ablation using a heated wire can correct the abnormal blood flow and restore normal circulation to the leg. The VNUS Closure Procedure is done under local anesthesia and allows immediate return to normal activity.

If you are concerned about a blood clot in your leg, be sure to seek medical attention so a critical health situation can be identified and treated if necessary.

Monday, July 18, 2016

Why It’s Important to Treat Varicose Veins

Patients come to us with varying presentations of varicose veins. Most patients notice a steady deterioration of worsening pain and discomfort as gravity causes more and more reflux as the months and years pass. Some patients will see progression of symptoms to more severe complications of varicose veins.

• Hyperpigmentation
If left untreated, varicose veins can cause blood leaking  through capillaries into the tissues of the leg. The patient will experience painful swelling and inflammation as parts of their skin become dark and discolored. This  is known as hyperpigmentation.

• Lipodermatosclerosis  

Venous reflux can lead to a continual low grade inflammatory process in the subcutaneous tissues of the leg.. The patient might feel that their legs are becoming increasingly tender with thickening of the skin of the lower leg. Lipodermatosclerosis is the term used to define the stiffening or hardening of the leg tissues.

Venous reflux can lead to tissue fragility of the lower leg and minor injury can cause the skin to break open. A venous leg ulcer ensues and becomes difficult to heal as the elevated venous pressures retard healing. Furthermore, ongoing venous reflux can cause these ulcers to recur frequently.. Venous leg ulcers tend to get larger over time, leading to increasing discomfort and irritation in the legs.

• Spontaneous Bleeding
Varicose veins tend to break down the walls of the skin over time as the elevated pressures damage the skin. This brings the varicose veins closer to the surface of the skin. In some cases, the slightest scratch or scrape can lead to excess blood loss. While the bleeding is usually painless, patients may experience significant blood loss if the condition goes untreated.

Superficial thrombophlebitis is a condition that involves the inflammation of the veins just beneath the surface of the skin. Varicose veins are subject to these clotting episodes as the flow becomes sluggish and irregular. Phlebitis causes pain and tenderness which takes quite a while to resolve.

Deep Vein Thrombosis is the most serious condition related to varicose veins because clots in the deep veins can break loose and travel to the heart or lungs. Superficial phlebitis noted above leads to DVT in over 10% of cases. Blood thinning medication is necessary in the treatment of DVT.

Who to See For Varicose Veins
Patients with varicose veins should seek a licensed specialist in their area for an initial evaluation. Vascular surgeons are best able to best determine the severity of the case in question and whether or not additional treatment methods are necessary. The term “vascular specialist” is used by some physicians who take weekend courses to learn vein care. Vein or vascular specialists do NOT have the same training and experience that vascular surgeons possess. Furthermore, some franchised vein centers incentivize their doctors to treat a target number of veins per month. You should be aware that these franchised centers may not have your best interests at heart.

Treating varicose veins all depends on the severity of the condition. In most cases, the refluxing vein is sealed using endovenous ablation, or removed using micro-phlebectomy, or injected using sclerotherapy. Many of these treatments are covered by your insurance payer and are office procedures allowing immediate return to normal activity.