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What it is:
Varicose veins and venous insufficiency develop when superficial veins, usually in the legs, stop functioning properly. All veins have check valves which allow blood to return to the heart as it is supposed to and prevent it from being pushed down by gravity. Over time, these veins can dilate, causing the check valves to no longer meet up and close in a proper time and fashion. Most patients have a family history of varicose vein disease but they also often occur in people who spend a large amount of time on their feet.
Symptoms:
As the veins dilate, legs can become achy, swollen, and painful. If left untreated, those with varicose veins can develop skin changes such as brownish discoloration, hardening of the skin, and nonhealing ulcers. Some sufferers also develop superficial blood clots that can become painful and which have a low risk of traveling to the lungs. Varicose veins are not just a cosmetic issue, but often will lead to pain in the legs which can limit the ability to do the activities of your daily life including working and other recreational activities.
Treatment:
Initial treatment of varicose veins is the use of compression socks, elevation, and over-the-counter pain medications. Most insurances require the use of compression socks for a period of time before they will approve surgical intervention. Once treatment with compression, elevation, and over-the-counter pain medications has failed or patients get more severe symptoms such as ulceration or phlebitis, surgical procedures are then considered. Most of these procedures can be done in an office-based setting. There are several different surgical treatment options depending on the individual. Those treatment options include closing of the saphenous venous system with either laser or radiofrequency ablation or use of a glue within the vein to shut it down. Other treatments include injecting medication into the vein to cause it to scar down.
What it is:
Pelvic congestive syndrome is very similar to venous insufficiency of the legs that occurs in the pelvic area. In this case, the internal iliac veins and/or gonadal veins dilate, leading to the symptoms.
Pelvic congestion syndrome (PCS) is one of the causes of chronic pelvic pain, a condition very common in women that can potentially lead to significant disability. Approximately one third of all women will suffer from chronic pelvic pain at some point during their lifetime. Chronic pain by definition lasts longer than six months and is not related to a woman’s menstrual cycle.
There are many different causes of chronic pelvic pain. This can make diagnosis difficult. Pelvic congestion syndrome (PCS) must be considered if the pain worsens when sitting or standing and is relieved with lying down. Some patients may also experience pain with urination (dysuria) or during/after sexual activity (dyspareunia). Symptoms of PCS are relatively consistent across the spectrum with a classic history of progressive pelvic heaviness and pain over the course of a day that improves after a night of rest.
PCS is associated with what is known as ovarian and pelvic vein dilatation. This can result in varicose veins in the pelvis, thighs, buttock regions or vaginal area. A complex medical condition, PCS requires a multidisciplinary team approach to treatment and evaluation.
Symptoms:
What it is:
May Thurner syndrome is the compression of the left common iliac vein by the right common iliac artery. This compression can lead to an increased risk of blood clots in the left leg and iliac system.
Symptoms:
May Thurner syndrome can lead to blood clots in the left leg and iliac venous system. Less commonly, it leads to an increased risk of left leg swelling and venous insufficiency without blood clots.
Treatment:
If a patient has blood clots secondary to May Thurner syndrome, they are usually first treated with medications to remove the blood clot. After the blood clot has been successfully dealt with, patients often have another procedure to look at the actual degree of narrowing of the vein and potentially a stent in the vein to prevent it from being compressed by the artery. This is usually done in an outpatient setting.
What it is:
Deep venous thrombosis is a blood clot usually found in one of the veins of the leg and less commonly within the arms. If left untreated, it can lead to a blood clot in the lung which can lead to severe shortness of breath or death.
Symptoms:
Deep venous thrombosis in the legs usually causes swelling and pain. Rarely are they asymptomatic.
Treatment:
Most deep vein thromboses are treated with simple anticoagulation. Occasionally, extensive blood clots are treated by either dissolving or removing them with a mechanical device. This is usually done through a simple poke hole through a vein to access the area. Sometimes they can be done in an outpatient setting and other times they require hospitalization for a short period of time.
