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Venous Insufficiency

Do you have swollen legs?

Leg Swelling Related to Fluid Buildup

Leg swelling caused by the retention of fluid in leg tissues is known as peripheral edema. It can be caused by a problem with the circulatory system, the lymphatic system or the kidneys. You may also experience swelling due to fluid buildup after sitting or standing for a long time.

Factors related to fluid buildup include:

  • Acute kidney failure
  • Cardiomyopathy (disease of heart tissue)
  • Chronic kidney disease
  • Cirrhosis (scarring of the liver)
  • Deep vein thrombosis (DVT)
  • Heart failure
  • Hormone therapy
  • Lymphedema (blockage in the lymph system)
  • Nephrotic syndrome (damage to small filtering blood vessels in the kidneys)
  • Pain relievers, such as ibuprofen or naproxen
  • Pericarditis (swelling of the membrane surrounding the heart)
  • Pregnancy
  • Prescription medications, including some used for diabetes and high blood pressure
  • Sitting for a long time, such as during airline flights
  • Standing for a long time
  • Thrombophlebitis (a blood clot that usually occurs in the leg)
  • Venous insufficiency, chronic (leg veins with a problem returning blood to the heart)

Iliocaval compression syndrome, the iliac artery compresses the iliac vein obstructing the flow of blood back to the heart.  

Symptoms

Signs and Symptoms of Venous Insufficiency / Iliocaval Compression Syndrome

  • swelling of the legs or ankles (edema)
  • pain that gets worse when you stand and gets better when you raise your legs
  • leg cramps
  • aching, throbbing, or a feeling of heaviness in your legs
  • itchy legs
  • weak legs
  • thickening of the skin on your legs or ankles
  • skin that is changing color, especially around the ankles
  • leg ulcers
  • varicose veins
  • a feeling of tightness in your calves

Treatment Options

Depending upon your age and the severity of the signs and symptoms, your doctor may want to order a specialized ultrasound test called venous mapping or venous duplex study.  This will provide information on the severity of reflux in the superficial and deep system.  A technician will place some gel on the skin and then press a small hand-held device (transducer) against your skin. The transducer uses sound waves that bounce back to a computer and produce the images of blood flow.

The most common treatment for venous insufficiency is prescription-wear compression stockings. These special elastic stockings apply pressure at the ankle and lower leg. They help improve blood flow and can reduce leg swelling. Compression stockings come in a range of prescription strengths and different lengths. Your doctor will help you decide what the best type of compression stocking is for your treatment.

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By seeing patients immediately in all offices, having our nurses available via telephone immediately, and by emphasizing proven preventative measures, we strongly try to avoid unnecessary, time consuming emergency rooms visits and unnecessary hospitalizations.

Treatment for Venous Insufficiency Can Include Several Different Strategies:

Improving Blood Flow

  • keep your legs elevated whenever possible
  • wear compression stockings to apply pressure to lower legs
  • keep your legs uncrossed when seated
  • exercise regularly

Medications

  • diuretics: medications that draw extra fluid from your body through your kidneys
  • anticoagulants: medications that thin the blood
  • pentoxifylline (Trental): a medication that helps improve blood flow

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Venogram with Intravascular Ultrasound (IVUS) evaluation

If the venous mapping study shows evidence of iliocaval compression syndrome, your doctor may want to image the iliac and common femoral veins with contrast dye and IVUS.  This is done by inserting a hollow tube (catheter) into the left and right common femoral veins.  Once this is completed your doctor will inject contrast dye causing the blood vessels to appear opaque on the X-ray image, which helps the doctor see them on the image.  The IVUS catheter will then be inserted through the catheter and placed in the distal inferior vena cava.  At this point the IVUS catheter will be withdrawn slowly to evaluate the inside of the blood vessel giving your doctor a 3-d representation of the vessel.  If the iliac vein or common femoral vein is found to be compressed a stent can be placed, acting as a scaffolding to support and keep the vein open.  This will improve blood flow back to the heart.  

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Minimally Invasive Vein Ablation Treatment

Endovenous (or vein) ablation is a minimally invasive outpatient treatment for venous insufficiency that is performed using ultrasound guidance. After applying local anesthetic to the skin over the vein, a Interventional Cardiologist inserts a thin tube known as a catheter, about the size of a strand of spaghetti, into the abnormal saphenous vein. Through this catheter, laser or radiofrequency energy is applied to the inside of the vein to seal it closed.

Reflux within one of the saphenous veins can lead to pooling in its tributaries (branches), causing visible varicose veins to develop and more blood for the surrounding normal veins to send back toward the heart. By closing the abnormal vein, the varicose veins—which are close to the skin—shrink and improve in appearance. In addition, once the diseased vein is closed, the surrounding healthy veins are no longer burdened by the leaking blood flow. Other healthy veins take over to carry blood from the leg, re-establishing normal flow.

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