There are three types of veins in the lower extremities: deep, superficial and perforator veins. These veins have valves in them which allow flow in one direction from feet to heart and from superficial to deep. Dysfunction of the vein valves, which may be from genetic predisposition, pregnancies, blood clots and trauma, can lead to leg swelling associated with pain, varicose veins, brownish discoloration of leg and ankle skin and open wounds (ulcers).
Valvular insufficiency of the main superficial veins (greater and lesser saphenous veins) leads to reversal of flow (reflux) which causes progressive enlargement of the branches of these veins which are called varicose veins. These veins have a tendency to get larger with time and can be associated with ankle and leg edema, discoloration of the leg and ankle skin and ulcers. Varicose veins can rupture causing bleeding and clot causing superficial thrombophlebitis and possibly deep vein thrombosis.
Varicose veins are evaluated with ultrasound examination. Treatment is individualized after thorough evaluation and includes elastic compression stockings, endovenous laser ablation of the saphenous veins, excision of veins and/or sclerotherapy. The majority of treatments is performed in the office. The Biolitec Ceralas E15 1470nm laser is used for endovenous ablation of the saphenous veins. This laser was recently approved by the FDA, is very effective and associated with minimal discomfort after the procedure.
Spider veins are small enlarged capillaries in the legs which are unsightly. Spider veins when present without any large varicose veins are not usually associated with saphenous vein valvular insufficiency. Causes of these veins include genetic predisposition, female hormones, pregnancy and birth control pills. These veins are usually asymptomatic. Treatment of these veins is usually for cosmetic reasons and included injection sclerotherapy and/or cutaneous laser therapy which are performed in the office. The Cutera Coolglide Excel laser is used for the cutaneous laser treatments.
Clots can develop in the deep veins of the lower (more common) and upper extremities which is called deep vein thrombosis (DVT). Risks factors include prolonged immobilization such as during a long flight and after trauma or surgery, cancer, birth control pills and hormone replacement therapy AND smoking. Symptoms include sudden painful swelling of the leg or arm which is warm to touch and tender.
DVT can break from the vein and migrate to the lungs through the heart causing a very serious (can be fatal) condition called pulmonary embolism (PE). Symptoms of PE include chest pains which can be worse with deep breathing, shortness of breath, coughing which can be bloody, palpitations, dizziness and syncope (passing out).
Most DVT can be diagnosed with an ultrasound examination. Other tests such as CT scan may be needed to complete the evaluation.
Primary treatment of DVT is through anticoagulants (blood thinners) which are administered for at least three months. In certain instances thrombolytic medications (clot busters) or vana cava filters may be necessary. As with other conditions treatment is individualized after thorough evaluation.