Chronic Venous Disease

Indications

When vein problems are left untreated, it can lead to long term problems such as swelling and pain. Complicated cases can progress to poor wound healing and ulceration.  These medical conditions need treatment.  There can be several potential abnormalities that can lead to chronic venous disease.   The first step is determining the underlying cause.  Your medical history may offer some clues.  Patients with a history of blood clots in their legs (DVT) or a long history of varicose veins can develop chronic venous disease.

An ultrasound examination is usually the first test performed to evaluate the veins in the legs. This looks for blood clots, narrowed veins and abnormal flow in the veins.  It is a painless test that usually takes less than 30 minutes to perform.  During this test, the sonographer places the ultrasound transducer on the leg and images the veins of the leg from the groin to the calf.  In some patients, a more advanced form of ultrasound is required. This is known as intravascular ultrasound (IVUS) which is a test performed in the hospital, usually with some sedation. During this examination, a catheter (small plastic tube) is placed into one of the veins in the thigh and a small ultrasound probe is then used to take pictures of the inside of the veins.  You may also receive a small dose of x-ray during this procedure. This test will look for narrowed veins in your pelvis that may be causing chronic venous disease. This particular condition is known as May-Thurner Syndrome, which means that the anatomically, an artery bringing blood to the right leg (right common iliac artery) may be close enough to put pressure on a vein draining blood from the left leg (left common iliac vein). This pressure may be enough to narrow the vein and alter flow enough to predispose a patient to chronic venous disease.

Procedural Details

Patients with chronic venous disease are usually treated first with conservative therapy. The objective of the conservative approach in treating chronic venous disease is to help support the venous circulation of the legs in order to slow the development of new veins and to minimize symptoms. Conservative treatment methods will not treat the underlying problems, but they do help slow the progression of the disease and alleviate symptoms such as swelling and pain and can help prevent new problems from developing. This can include the use of compression stockings and/or anticoagulation (blood thinners) to prevent more clots from forming.

Endovenous Ablation is another option for chronic venous disease. Ablation is performed in the office as a minimally invasive method for treating reflux in the saphenous veins.  Under ultrasound guidance, a tiny catheter is inserted directly into the vein.  The catheter uses radio frequency energy to heat the inside of the vein wall. This causes the vein to seal shut.  This procedure is performed through a small nick in the skin and local anesthesia. The patient walks out of the office and may return to his or her normal daily routine within 24 hours.  This technique can be combined with ambulatory phlebectomy for the treatment of ropy varicose veins.  Patients continue to wear compression stockings after this procedure to encourage wound healing and to control edema.

Chronically narrowed or occluded veins can be opened using a combination of techniques. These procedures are performed in the hospital under sedation. During this procedure, a catheter is placed into a leg vein. Using x-rays as our guide, we can pass this catheter through the narrowed or blocked vein, and begin the process of opening the vein. Sometimes, a balloon will be placed in the vein and inflated, to stretch open the narrowed vein.  Often, we will place a small metal stent in the vein to hold it open.