Vascular Health Awareness

As we enter the changing of the seasons in September, it is also important to recognize that it is Vascular Disease Awareness Month. Vascular disease, affecting both the arteries and veins in your body, can lead to life-changing health problems if not properly screened and evaluated when appropriate.

Whether it is concerns of a stroke, aneurysm, sources of leg pain/swelling, varicose veins, or spider veins, these topics should always be discussed by your provider. One of the most common vascular diseases hidden in the shadows is vein disease, also referred to as venous insufficiency or venous reflux disease.

What is venous insufficiency?

Venous insufficiency refers to the dysfunction or leakage of the “one-way check valves” in our veins. These “check valves” enable the blood to fight against gravity with the assistance of the muscles, carrying deoxygenated blood back to the heart and lungs. However, when these valves are not adequately snapping closed, blood will “leak” backward with gravity, pooling in the veins of the legs and feet. This is known as “venous insufficiency” or “venous reflux disease.” It tends to have a significant association with family history but can be caused by other individualized factors.

What findings suggest venous insufficiency?

This disease process can present itself in numerous ways. Most people notice more obvious physical findings such as small spider veins on their thighs, lower legs or ankles, or perhaps prominent varicose veins in these regions. However, it can also contribute to leg swelling, leg pain, heaviness, skin discoloration, fatigue, and even prevent sores of the legs from healing if severe enough. To further evaluate the function of the veins, an ultrasound can assess the competency of the valves to better define the location of venous reflux.

What can be done to help?

There are various ways to treat venous insufficiency. Initially, conservative measures are recommended. These include using appropriately fitted compression stockings, elevating the legs intermittently throughout the day, and participating in a cardiovascular exercise regimen. If these means do not adequately control symptoms and provide relief, procedural options can be considered.

Treating the superficial venous system often entails closing a portion or portions of the leaky vein to reduce the backpressure that develops in the legs throughout the day. This is done by inserting a small catheter into the vein under ultrasound through a little nick in the skin. The catheter then emits ultrasound energy into the vein wall or injects a type of fluid into the vein, which causes the vein to contract down and seal off. The patient’s blood-flow will then be diverted by the body into normal, functioning veins. This diversion of blood decreases the pressure in one’s varicose veins.

When the pressure is lower in the veins, they will cause less symptoms and shrink in size. If the varicose veins are still symptomatic or cosmetically unacceptable after closing the source veins, the varicose veins can be removed through a series of tiny incisions, or injected with a type of fluid that causes the veins to shrink and close off, which is called sclerotherapy.

What else can be found?

Lastly, most patients with venous insufficiency present with symptoms and physical findings in their legs, but patients can also have venous insufficiency in their pelvis, known as “pelvic congestion syndrome.” Based on the patient’s presenting signs and symptoms, there may be concerns for narrowing or reflux in the veins of the pelvic area, resulting in a buildup of pressure. Initial work-up of this diagnosis typically involves a CT scan of the abdomen and pelvis to evaluate for any compression of the veins as well as an ultrasound of the legs. If the diagnosis is suggested, a venogram, a procedure where a small catheter is placed in the veins of the pelvis, is used to assess whether there is normal appearance and function of the veins. When there is significant compression or narrowing of these veins, a stent may be placed to open the veins and treat any narrowing, allowing the blood to drain out of the pelvis more efficiently.

What should you remember?

Do not discount Vascular Disease Awareness Month. Take the time to discuss with your primary care provider or other specialist if there are any concerns. It may even be a worthwhile consultation to have with a vascular surgery provider to help further determine if you are at risk of vascular disease.