VEIN DISEASE
About vein care at Osler Vascular & Vein
Understanding Vein Disease
Healthy leg veins have valves that keep blood flowing to the heart. Venous reflux disease develops when the valves stop working properly and allow blood to flow backward (i.e., reflux) and pool in the lower leg veins. If venous reflux disease is left untreated, symptoms can worsen over time.
Spider Veins and Reticular Veins
Spider veins are the smaller pink and blue veins commonly found on the thighs, calves, ankles and feet. They are often fed by larger, bluer veins called reticular veins. Although they can be unsightly, they can also cause symptoms described as stinging, burning or aching.
Spider Vein Treatments
We recommend sclerotherapy to treat spider veins. This safe and effective treatment is a common procedure performed in our offices. This involves using a specialized vein light to identify any ‘feeder’ veins under the skin as the root cause of the spider veins. These reticular feeding veins and spider veins can then be successfully injected with sclerosant.
The sclerosant is a medication to irritate and close the vein. For most sclerotherapy treatments, we require you to wear compression stockings for up to 2 weeks after treatment for best results.
Most spider vein treatments require at least 3 treatment sessions. If you have many spider veins, treatment may require more than 3 sessions. We suggest treatment intervals of about 4 weeks or so. This means that most spider vein treatments will take place over 3 months.
Varicose Veins
Varicose veins are enlarged, twisting veins found on the legs, usually from faulty valves of veins deeper in the skin. They are sometimes blue or dark purple. People with bulging and/or lumpy varicose veins on their legs may experience cramping pain, heaviness, itching or aching.
Nonpainful varicose veins are usually related to larger vein problems under the skin, which eventually may become painful. Occasionally, untreated varicose veins can develop phlebitis, which is caused by clotting and can lead to painful, red, hot, swollen and very tender varicose veins. Skin colour changes called pigmentation are usually permanent. Eventually, open sores (ulcers) may form on the skin if not treated.
Varicose Vein Treatments
Varicose veins result from larger, nonfunctioning veins under the surface. An ultrasound of the legs can find the cause. Several types of techniques can be used to close off the vein and reduce the high venous pressure to the varicose vein depending on a patient’s needs.
The main treatments for varicose veins include two categories: surgical stripping and endovenous surgery.
Surgical stripping is not as frequently performed anymore due to risks and a prolonged recovery period but remains a safe and highly effective option.
Endovenous surgery is a well-established method that is minimally invasive and can safely be performed outside of a hospital.
The two main endovenous techniques are called “thermal” vs “non thermal” ablation.
Thermal ablation means a small catheter uses heat to close the veins using a laser or RFA probe.
The newer “non thermal” techniques use a small catheter to close the vein without any heat energy. These newer techniques include Venaseal and Clarivein.
In our practice we believe the best, safest, state-of-the-art techniques are the non-thermal endovenous therapies, including Venaseal or Clarivein. Your doctor can discuss the pros and cons of each treatment.
Once the greater or short saphenous veins veins are treated using Venaseal or Clarivein, some patients will require treatment of the smaller tributary or branch veins using sclerotherapy, a small amount of solution is injected through a tiny needle directly into the unsightly vein.
Sclerotherapy would be performed a few weeks after your Clarivein or Venaseal treatment. The sclerotherapy solution injures the vein wall, causing it to close. Over time, the body reabsorbs the vein, giving the appearance of gradual fading.
About Clarivein
Unlike Laser and RFA, which uses thermal energy or heat to close veins from the inside, the MOCA procedure (Mechanical Occlusion with Chemical Assistance), otherwise known as ClariVein, uses a blunt-ended, rotating fiber that gently, but rapidly spins in the inside of veins, agitating the lining, while a medication used to normally treat veins is then injected to assist in the closure of the abnormal vein. Laser and RF have a limitation in that they require numbing around the vein to protect the tissue from being injured by the heat. The numbing is effective, but laser and RF cannot be used in the lower calf due to potential nerve injury. Because ClariVein works strictly inside the vein, there is no risk of nerve injury. No anesthesia is necessary. Patients experience a vibration sensation. It is performed through a tiny entry point — no stitches or staples. The procedure is quick, performed while you are awake, in the office avoiding hospitalization, and you will be able to immediately walk and return to most activities with few limitations.
About Venaseal
The VenaSeal™ procedure is the only non-thermal, non-tumescent, non-sclerosant procedure that uses a specially formulated medical adhesive delivered endovenously to close the vein. This unique approach eliminates the risk of thermal nerve injury when treating the small saphenous vein, which is a risk sometimes associated with certain thermal-based procedures. Clinical studies have demonstrated that the procedure is safe and effective. The procedure is administered without the use of tumescent anesthesia, avoiding patient discomfort associated with multiple needle sticks.
What is Compression Therapy?
Compression therapy, or compression stockings, are usually recommended as a first step to help with the symptoms of vein disease. There are many varieties of stockings on the market, but for leg pain, varicose veins, and leg swelling, we recommend wearing “graduated” compression hose, which are designed to have higher compression at the ankle, and gradually become less tight as they rise up the leg. They work by keeping blood from pooling in the lower leg veins, and allow better circulation, which reduces the swelling and pressure resulting in aching, itching, and restless legs. Over-the-counter non-prescription stockings usually do not achieve the compression needed to improve symptoms. Newer styles wick away moisture, are breathable, and much more comfortable than the older styles of the past. There are varieties designed to wear when running or exercising as well. We recommend wearing graduated support stockings following vein treatments as they help aid in speeding up recovery and reducing any post treatment discomfort. Many studies show they help in the pain and recovery from blood clots, including Deep Vein Thrombosis (DVT) and phlebitis (varicose vein clots closer to the surface).
Deep Vein Thrombosis and Post Thrombotic Syndrome (PTS)
Acute DVT has excellent treatment success with anticoagulation. However some patients will have an “iliofemoral DVT”, which means a proximal blood clot that obstructs the blood flow return from the leg.
These patients can present with severe leg swelling, pain, and sometimes even phlegmasia or ischemia. For appropriate patients, there is new evidence that blood clot removal in the acute setting using either mechincal thrombectomy or a potent blood thinner called TPA can open the veins faster and preserve valve function better than anticoagulation alone. The goal of treatment is to prevent post thrombotic syndrome.
Post thrombotic syndrome are the more chronic symptoms from a prior deep vein blood clot. These symptoms typically develop months to years after a blood clot, and can include pain, leg swelling that is difficult to treat, and ulcers that keep coming back.
Treatment of post thrombotic syndrome is challenging and requires a team approach. We will determine if your symptoms are due to vein reflux, obstruction, or both, and offer customized treatments best suited to your vein pathophysiology.
Leg Swelling, Skin Changes, or Vein Ulcers
Patients with leg swelling, skin pigmentation, or vein ulcers typically have the most advanced vein dysfuction, meaning the valves usually have severe reflux.
A lot of these patients may also have what we call “multisystem” vein disease, where the iliac veins, deep veins, superficial veins, or perforator veins are not working well. These patients require careful evaluation to determine if the vein problem is due to reflux (leaking valves), obstruction (narrowing of the valve causing obstructin) or both.
We are dedicated to helping the most severe patients heal their ulcer, decrease their swelling, and improve their quality of life.
Phlebtitis
Blood clots can form in either the deep or superficial veins of the body. If a blood clot forms in the superficial veins, it is commonly called phlebitis or superficial vein thrombosis (SVT).
When a blood clot forms in a superficial vein, the vein usually becomes warm, red along the vein, and painful to touch. It can feel quite firm.
If you have phlebitis, you should have an ultrasound to make sure there is no blood clot in the deep veins.
Phlebitis Treatment
Temporary treatment includes pain relievers such as Ibuprofen or Naproxen (anti-inflammatory medicine found over the counter or by prescription). We will recommend the following:
- wearing prescription-strength graduated support hose and encourage frequent walking.
- leg elevation, keeping your legs above your heart when at rest
- topical ice packs
- sometimes your doctor will prescribe a short course of anti-coagulation or blood thinners to treat the phlebitis
Phlebitis can come back. To prevent recurrent episodes of phlebitis, the cause should be determined with a vascular lab ultrasound. This usually identifies the problems veins that can then be treate
Pelvic Congestion Syndrome
Pelvic venous congestion syndrome is also known as ovarian vein reflux and is a common cause of chronic pelvic pain in women.
Chronic pelvic pain is pain in the lower abdomen which has been present for more than 6 months. Pelvic congestion syndrome is therefore a painful condition often caused by dilatation of the ovarian and/or pelvic veins, similar to varicose veins but in the pelvis . Varicose veins are commonly seen in the legs when the veins become less elastic and the valves that stop the blood from flowing backwards stop working. This causes the blood to pool, due to gravity, causing enlarged, bulging and knotty veins. This is also what happens to the pelvic veins in pelvic venous congestion syndrome (PVCS). This pressure results in the pain of PVCS and may also cause visible varicose veins around the vulva, vagina, inner thigh, sometimes the buttock and down the legs.
The symptoms of PVCS are due to the dilatation of the pelvic veins and because the blood is flowing the wrong way (i.e. backwards).
The varicose veins in the pelvis surround the ovary and can also push on the bladder and rectum. This can cause the following symptoms:
- Pelvic pain or aching around the pelvis and lower abdomen
- Dragging sensation or pain in the pelvis
- Feeling of fullness in the legs
- Worsening of stress incontinence
- Worsening in the symptoms associated with irritable bowel syndrome
The pain is usually on one side but can affect both sides. The pain is worse on standing, lifting, when you are tired, during pregnancy and during or after sexual intercourse. The veins are also affected by the menstrual cycle/hormones and therefore the pain can increase during the time of menstruation. The pain usually is improved by lying down.
One form of treatment is endovenous pelvic vein embolisation. This is a minimally invasive treatment that is safe and can be done as a day procedure. In most cases it is the ovarian vein that is the cause of the varicose veins. However other pelvic veins such as veins called the internal iliac vein, internal pudendal vein, obturator vein and ischial veins may also be responsible and need treating as well. Treatment involves using small coils or medication to close off the veins that are not working.