Many of us experience leg discomfort, especially at the end of the day. However, there are a number of symptoms that can point to the possibility that someone has chronic venous insufficiency: heaviness, aching, swelling throbbing, itching, and/or cramping in your legs. Another indication is restless leg symptoms such as inability to rest at night due to a feeling of something crawling on your legs, and having to get out of bed to "walk off the heebie-jeebies" in your legs.
Venous insufficiency is seen in 20 to 30 percent of the population in the western world. About 11 million men and 22 million women ranging from 40 to 80 years of age suffer from this problem and are unaware of the underlying disease process. This is because of the mistaken understanding that there is no vein disease present unless the legs are involved with numerous small spider-like veins or with obvious ropey varicose veins. Most of us tend to tolerate the symptoms because they develop slowly over a number of years.
There are several risk factors that make someone prone to having venous disease. Heredity is the most common one, and females are twice as likely to have an early onset of symptoms following multiple pregnancies. Obesity, prolonged sitting or standing, and aging tend to contribute to worsening of vein problems. There is no way to prevent venous disease, but conservative treatment using compression hose, preferably 20-30 mm Hg, elevation of the legs in the morning and afternoon, and active exercise help reduce the symptoms.
When someone has the symptoms described above, one of the best evaluation of the legs is through an ultrasound study of the leg veins which is done at vein centers. This study is painless and takes about a half hour to complete as an outpatient visit. Veins bring back blood from the legs to the heart, and they have valves that prevent blood from falling back down. The ultrasound examination looks at the enlargement of the veins, and if there is any leakage of the vein valves. A consultation with a physician to discuss the findings and treatment process usually follows.
The modern day treatment of chronic venous insufficiency, a term signifying advanced venous disease, is performed as an office-based procedure using local anesthesia. The major superficial veins that have leaky valves are sealed off with a heat probe, and the ropy varicose veins are removed with microphlebectomy, which removes the veins with a special hook. These procedures are now covered by most insurance carriers. A compression dressing is then applied, and the patient walks out of the office and is active the rest of the day. Treatment of telangiectasia such as spider veins and of reticular veins is deemed cosmetic and is not covered by insurance companies. Sclerotherapy is a method to treat spider veins, which involves injecting a solution into these small veins to shut them down. This is also an outpatient procedure, and is offered as a cash-only procedure. Follow-up studies are performed at two weeks and six months post procedure.
James Isobe, MD practices vascular medicine at the Brookwood Baptist Health Vein Center Hoover.