Chronic Venous Insufficiency Hollywood FL - Pembroke Pines FL - Fox Vein & Laser Experts I Miami Vein and Laser Experts

Chronic Venous Insufficiency

Chronic Venous Insufficiency affects around one in 20 adults. The prevalence is around 25 percent to 40 percent women and 10 percent to 20 percent men. Annually, 2 percent to 6 percent women and 1.9% of men develop CVI. It is estimated that around 30 percent of the population has some degree of venous insufficiency. Only 1/10 of the people seek treatment. Chronic venous insufficiency affects both young and older adults. In people more than 45-years-old, vein disease is most common.

Primary Causes of Chronic Venous Insufficiency

Chronic Venous Insufficiency

There are valves in veins in the legs to help blood return to the heart. These valves open towards the heart and keep the blood flowing up the legs. When the muscles contract the valves open and keep the blood moving in one direction.  Sometimes, these valves do not work correctly. Instead of all of the blood going back to the heart, some of the blood drips back down and pools in the leg veins.

This causes the veins in the legs to become twisty and varicosed. The veins stretch and twist and become enlarged. Muscle contractions and valves in the veins in the legs help the blood return to the heart. When they do not work correctly, the veins become varicosed and the legs become symptomatic.

Risk factors promote the increase of varicose veins and venous insufficiency. Several risk factors include:

Pregnancy: During pregnancy, the blood volume increases and the veins relax allowing the mother to have the ability to support a growing baby. This, plus the increased weight and pressure of the baby and uterus, often increases the amount of varicose veins and enlarges the veins.

Gender: Women are more prone to developing varicose veins and venous insufficiency.  Hormones associated with menstrual cycles and pregnancy cause the veins to weaken and relax.  Symptoms often worsen near a woman’s menstrual cycle.

Age: As the valves in the legs age, they weaken and often allow blood to flow backwards and pool.

Family History: If your mother and/or father have vein issues, your risk increases greatly with each family member affected.

Obesity: Increased weight increases stress on the venous and lymphatic systems.

Occupations: Occupations where you stand or sit for long periods frequently causes the legs to swell, feel heavy and ache. Contracting the calf muscles improves blood flow as it returns to the heart. This movement helps with venous blood return.

Congenital: There are some congenital malformations and inherited defects that can cause vein problems. These present young in life and are often due to a lack of valves in the veins of the leg.

Deep venous thrombosis: The blood clot in the deep veins damages the valves in the veins. Blood clots, especially extensive blood clots, cause venous insufficiency.

Secondary Cause of Chronic Venous Insufficiency

Other medical issues such as masses or tumors press on the leg veins and impair venous return of blood to the heart. These can cause thrombus or increase pressure in the veins and cause venous insufficiency.

Most Common Cause of Chronic Venous Insufficiency

Deep venous thrombosis is the most common cause of venous insufficiency. Deep clots in the veins damage the valves inside the veins and contribute to back flow in the veins. This causes it to leak backwards and pool. This often leads to leg swelling and skin changes.

Complications that Contribute to Chronic Venous Insufficiency

When the body begins to experience complications that impact overall health, venous insufficiency often contributes to such conditions. Here are some complications:

Skin Changes: As venous insufficiency worsens, skin changes become more apparent.

This often starts with darkening of the skin, hemosiderin deposition. With this condition, the skin discolors. The skin casts a bronze color.

As well,venous eczema, scaling and skin changes, begins to gradually occur.  The skin becomes, irritated, rashy, red, itchy and inflamed. Over time, there may be hardening or thickening of the skin where it becomes woody in texture. This is known as lipodermatosclerosis. Sometimes this is associated with white cigarette like paper scars of the skin called atrophie blanche.

Over time, these skin changes can lead to skin breakdown and cause skin ulcerations. These ulcers become hard to heal and account for many days of lost work. It often takes five months to two years or more to heal. They often recur.

Blood Clots: Blood clots can damage valves in the veins.  The veins in the legs can become enlarged and problematic causing swelling, heaviness, aching ,and other problems.

Bleeding Veins: Bleeding veins causes pressure increases inside the veins. If the superficial vein is scratched or nicked from the outside, bleeding can result. This bleeding may be profuse. Often, it requires calling EMS or going to an ER for stitches or cauterization of the vein.

Stages of Chronic Venous Insufficiency

chronic venous insufficiency

The CEAP Classification is used to grade the stages of venous disease. There are six classifications of venous disease, and these include:

C Classification

Stage 0: No signs venous disease

Stage 1: Visible blood vessels include spider veins, thread veins and telengectasias

Stage 2: Varicose Veins at least 3mm wide

A) Without symptoms means asymptomatic

B) With symptoms or symptomatic means aching, pain, swelling, heaviness, cramping, skin changes, tiredness, or tightness in the legs due to venous disease

Stage 3: Edema (swelling) in legs and/ or ankles without skin changes

Stage 4: Discoloration of the skin

A) Pigmentation or eczema

B) Lipodermatosclerosis or atrophie blanche

C) Corona Phlebectatica

Stage 5: Healed venous ulcer

Stage 6: Active venous ulcer or R for Recurrent ulcer

Etiology: E Classification

C: Congenital

P: Primary

S: Secondary (post Deep Vein Thrombosis)

N: No Venous disease noted

Anatomical Classifications:  A classification

S: Superficial Veins

P: Perforator veins

D: Deep Veins

N: No venous disease identified

Pathophysiology: P Classification

R: Reflux

O: Obstruction

R, O: Reflux and obstruction

N: No venous disease noted

Vein Treatments for Chronic Venous Diseases

Beyond conservative management of superficial venous disease, there are other options, and these include:

Vein Stripping: Incisions are made in the groin, knee area and often the ankle area.  A stripper device is tied and threaded in the vein and the veins are pulled out and removed.  This is not performed much anymore due to risks of nerve injuries, higher recurrence, general anesthesia issues, infections, time out of work and more.

Endovenous Laser Ablation:

Endovenous laser ablation provides patients with the following benefits:

Procedure Followed by Vascular Surgeon During Endovenous laser Ablation:

 A laser and catheter are placed inside the vein under ultrasound guidance. Usually, there’s no need to make incisions or cuts in the skin. The procedure is done under local anesthetic (lidocaine). The patient is awake and returns to normal activity even immediately afterwards.

The laser is placed inside the vein and is used to heat the vein to close this malfunctioning vein. The body diverts the blood to better veins that are working correctly.

First the vein is mapped with ultrasound. The skin is numbed with local anesthetic. Then, a catheter is placed in the vein and a laser is placed inside the catheter and threaded to be two centimeters from the deep vein.

Tumescent anesthesia (a very diluted local anesthetic) is placed around the vein under ultrasound guidance. The laser is fired and used to heat seal the vein shut from the inside. Everything is gradually removed. The leg is rescanned immediately after the procedure and usually within one week.

The patient is placed in a compression hose 20 to 30 mm/hg is most commonly used. Patients are advised to walk and stay active. We often recommend that most people resume normal activities even immediately afterwards. On occasion NSAIDS or Tylenol can be used for discomfort.

Radiofrequency (RF) Ablation: Why might I need Endovenous Surgery?

Your physician may suggest venous procedures to close or remove veins if they are becoming more bothersome. This decision occurs after trying and failing around six months or more of conservative vein treatments including: compression hose, leg elevation, anti-inflammatories, calf exercises and possibly micronized flavonoids.

In this treatment, the vein is mapped with an ultrasound.  Then, under ultrasound guidance, the skin above the vein is numbed with local anesthetic and a catheter is placed inside the problematic vein.  The catheter holds the vein open so that the radiofrequency catheter can be placed inside the vein.  Tumescent anesthesia (a diluted local anesthetic) is placed around the vein.

Once the area is well numbed, the radiofrequency catheter is fired around two centimeters distal to the deep vein to the exit site. The radiofrequency device and catheter are removed and the patient is placed in compression hose and advised to walk and stay active.  There is little to no downtime. It is done in the office, normally under only local anesthetic and most regular activities can be resumed almost immediately. A follow-up ultrasound is performed immediately afterwards and within one week of the procedure. Blood reroutes from the closed problematic veins to healthy veins nearby.

 Venaseal: The vein is mapped with an ultrasound. A glue similar to crazy glue is injected into the vein to close the vein and seal it shut. No downtime, no heat, no compression hose are required afterwards. However, a significant number of patients have moderate sensitivity reactions to the glue and may need antihistamines or steroids afterwards.

Varithena: This is sclerotherapy which is targeted towards large veins or venous insufficiency under ultrasound guidance. Varithena uses polidocanol (asclera) in a foamed form. It is injected under ultrasound guidance in the office through a needle or small catheter using a septic technique. This is a non thermal, non tumescent vein ablation procedure that is used to treat venous insufficiency in the superficial varicose veins or venous insufficiency.  Varithena is FDA approved and available to be performed in the office without downtime.  It can have up to a 97% success.  This procedure is often used for recurrent veins, and varicose veins after endovenous procedures.  The patient is advised to wear compression hose for the two weeks after injection. There is a maximum amount of solution that can be used in one sitting. Heavy lifting exercises should be avoided.

Side effects of Varithena:

Allergic reactions if allergic to Polidocanol

Blood clots

Heart attacks and strokes usually if there is a hole in the heart

Pregnancy and breast feeding are contra-indications (the physician will request no breast feeding post injection

Vein Treatments

Chronic Venous Insufficiency

Beyond conservative management of superficial venous disease, there are other options, and these include:

Vein Stripping: Incisions are made in the groin, knee area and often the ankle area.  A stripper device is tied and threaded in the vein and the veins are pulled out and removed.  This is not performed much anymore due to risks of nerve injuries, higher recurrence, general anesthesia issues, infections, time out of work and more.

Endovenous Laser Ablation: Endovenous laser ablation provides patients with the following benefits:

Procedure Followed by Vascular Surgeon During Endovenous laser Ablation:

 A laser and catheter are placed inside the vein under ultrasound guidance. Usually, there’s no need to make incisions or cuts in the skin. The procedure is done under local anesthetic (lidocaine). The patient is awake and returns to normal activity even immediately afterwards.

The laser is placed inside the vein and is used to heat the vein to close this malfunctioning vein. The body diverts the blood to better veins that are working correctly.

First the vein is mapped with ultrasound. The skin is numbed with local anesthetic. Then, a catheter is placed in the vein and a laser is placed inside the catheter and threaded to be two centimeters from the deep vein.

Tumescent anesthesia (a very diluted local anesthetic) is placed around the vein under ultrasound guidance. The laser is fired and used to heat seal the vein shut from the inside. Everything is gradually removed. The leg is rescanned immediately after the procedure and usually within one week.

The patient is placed in a compression hose–20 to 30 mm/hg is most commonly used. Patients are advised to walk and stay active. We often recommend that most people resume normal activities even immediately afterwards. On occasion NSAIDS or Tylenol can be used for discomfort.

Radiofrequency (RF) Ablation: Why might I need endovenous surgery?

Your physician may suggest venous procedures to close or remove veins if they are becoming more bothersome. This decision occurs after trying and failing around six months or more of conservative vein treatments including: compression hose, leg elevation, anti-inflammatories, calf exercises and possibly micronized flavonoids.

In this treatment, the vein is mapped with an ultrasound.  Then, under ultrasound guidance, the skin above the vein is numbed with local anesthetic and a catheter is placed inside the problematic vein.  The catheter holds the vein open so that the radiofrequency catheter can be placed inside the vein.  Tumescent anesthesia (a diluted local anesthetic) is placed around the vein.

Once the area is well numbed, the radiofrequency catheter is fired around two centimeters distal to the deep vein to the exit site. The radiofrequency device and catheter are removed and the patient is placed in compression hose and advised to walk and stay active.  There is little to no downtime. It is done in the office, normally under only local anesthetic and most regular activities can be resumed almost immediately. A follow-up ultrasound is performed immediately afterwards and within one week of the procedure. Blood reroutes from the closed problematic veins to healthy veins nearby.

Venaseal: The vein is mapped with an ultrasound. A glue similar to crazy glue is injected into the vein to close the vein and seal it shut. No downtime, no heat, no compression hose are required afterwards. However, a significant number of patients have moderate sensitivity reactions to the glue and may need antihistamines or steroids afterwards.

Varithena: This is sclerotherapy which is targeted towards large veins or venous insufficiency under ultrasound guidance. Varithena uses polidocanol (asclera) in a foamed form. It is injected under ultrasound guidance in the office through a needle or small catheter using a septic technique. This is a non thermal, non tumescent vein ablation procedure that is used to treat venous insufficiency in the superficial varicose veins or venous insufficiency.

Varithena is FDA approved and available to be performed in the office without downtime.  It can have up to a 97% success.  This procedure is often used for recurrent veins, and varicose veins after endovenous procedures.  The patient is advised to wear compression hose for the two weeks after injection. There is a maximum amount of solution that can be used in one sitting. Heavy lifting exercises should be avoided.

Side Effects of Varithena:

If you want to learn more about your options for chronic venous insufficiency treatment, Call our office of Fox Vein & Laser Experts at 954-627-1045 to schedule a consultation with our vein doctor Miami.

FAQs about Chronic Venous Insufficiency

What do I do if I have venous insufficiency?

We recommend conservative measures if you have venous insufficiency:

Wear compression hose at least 20 to 30 mm/hg daily from first thing in the morning until one lies down at night.

Elevate the legs when able during the daytime and during sleep so the legs are positioned above the heart

Micronized flavonoids are Rustin derivatives that have been shown to possibly decrease the onset of new veins and help the symptoms of venous disease

Good skin care that includes moisturizing, prevents skin breakdown. See a Miami vascular physician at any signs of an ulceration or sore. When there is swelling and openings in the skin, this can lead to cellulitis or an infection in the superficial tissues. It is very important to prevent this.

Exercise regularly: Strong muscles in the legs helps the blood move up the legs.

Weight management: Maintaining a healthy weight helps reduce many conditions in the body.

Anti-Inflammatories: Medications like ibuprofen, Diclofenac, and Naproxen help decrease inflammation and also help discomfort.

What Are the Symptoms of chronic venous insufficiency?

When should I see a physician for venous insufficiency?

See your health care provider if you have any symptoms related to vein disease that are worsening or becoming bothersome. They will do a physical exam, get some history and information about medical symptoms and conditions. Then, your Miami vascular physician may order imaging. This may include non-invasive duplex ultrasound to make sure there is no evidence of blood clots. The doctor examines the veins for venous insufficiency or back flow in the valves.

Why might I need endovenous surgery?

Your vascular physician may suggest venous procedures to close or remove veins. This recommendation comes if and when the veins become more bothersome. It also occurs with attempts and failures to reverse the condition.

People should attempt six months worth of conservative vein treatments:

If you have tried and failed around six months or more of conservative vein treatments including:

When these fail, the Miami vascular surgeon may suggest venous procedures. In this case, the patient is getting more varicose veins, leg swelling, heaviness, pain, aching, skin changes and other problems. They have tried and failed non-procedure treatments and this is the next step.

When should I go to the Emergency Room?

If there is worsening swelling or pain in the leg and/or signs of a pulmonary embolism, head immediately to the emergency room. The signs of a pulmonary embolism are sudden onset of shortness of breath, problems breathing, leg swelling, palpitations or irregular heart beats, chest pain, chest pain with a deep breath, and impending sense of doom.

What can I do to prevent venous insufficiency?