Leg ulcers, an advanced stage of vein disease

Leg ulcers can occur at any stage of life and, without treatment, can cause overwhelming problems. 

When blood pools in the lower leg over a long period of time, the condition is referred to as venous stasis. When blood leaks into the tissue of the skin it can cause swelling and damage to the tissue. Tissue damage can result in wounds, or ulcers, that are chronic and do not heal if the condition is left untreated. Ulcers may be painful or itchy and often require constant care and dressing.

There are three large classes of ulcers: diabetic, arterial, and venous. Of the three types, venous, or vein-related, is the most common. In fact, venous disease is thought to account for approximately 80% of chronic leg ulcers. Venous ulcers can be caused by venous insufficiency or by a wound that has been exacerbated by venous insufficiency. 

Leg ulcers are often an indication that vein disease has reached an advanced stage. However, the key to properly treating and managing them is to first get them diagnosed. Though ulcers may appear similar, each one has a different cause and thus, very different treatments.

Clinical appearance is the first clue to distinguishing between venous and arterial ulcers. Typically, venous ulcers can appear anywhere between the knee and the ankle, while arterial ulcers are usually found between, or on the tips of, toes.

Another sign is discoloration. Venous-related wounds tend to be ruddy, and the surrounding tissue may be red or hyper-pigmented due to hemosiderin (a pigment formed by the breakdown of hemoglobin). In contrast, the wound bed of an arterial ulcer tends to be black, grayish, or yellow.

The most effective way to diagnose a venous ulcer is with a duplex Doppler ultrasound, which reveals whether or not the blood is flowing in the proper direction, or if there is any pooling occurring.

Ulcers do not heal on their own, but even those who are already experiencing this late-stage symptom can have excellent success with treatment. If you have skin breakdown or infection due to ulceration, you should visit your doctor immediately.

Using ultrasound for vein treatment

Ultrasound is an essential tool in vein care, as well as non-invasive and comfortable for the patient. In addition to mapping a patient’s veins and diagnosing vein disorders, ultrasound is used throughout the treatment of veins, acting like the physician’s “eyes inside the leg.”

After a diagnostic ultrasound is performed and the doctor establishes a treatment plan to fix the problem, ultrasound may be used. In endovenous laser ablation for example, seeing where the healthy vein connects with the unhealthy vein is very important; ultrasound is the best modality to visualize this area.

Another example is ultrasound-guided sclerotherapy, which uses the guidance of ultrasound to find leaking veins that are not visible and can’t be seen with a hand-held light used to view veins near the surface (transcutaneous illumination). Ultrasound-guided sclerotherapy is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in the leg) to the deep system (veins under and between the muscles of the leg).     

After the vein treatment and a designated amount of time for healing, the physician will use ultrasound again to assess the effectiveness of the treatment plan.

What is ultrasound mapping?

Vein disease, which often manifests as varicose veins, is defined as the impairment of blood flow towards your heart. Oxygenated blood is constantly being pumped from the heart to the rest of our bodies through arteries. It is the job of our veins to carry deoxygenated blood back up to the heart.

Healthy veins have valves that open and close to assist the return of blood to the heart. Vein disease occurs when these valves become damaged, allowing the backward flow of blood in the legs where it can pool, leading to a feeling of heaviness and fatigue and causing varicose veins or other skin changes.

Ultrasound is a tool used to diagnose if and where a vein valve (or multiple valves) in the legs is damaged. High-frequency sound waves are used to create images that allow the doctor to see which veins have flow going in which direction—like a road map for the venous system.

A healthy vein will only allow flow from the feet towards the heart. Faulty veins are often connected, so finding the “source” of the problem is a complicated, but critical, step in establishing where exactly treatment should start.

Ultrasound is the gold standard for evaluation of chronic venous disease, and it is important to have a qualified sonographer perform the mapping in order to have accurate diagnostic results. To learn more about what to expect at a vein evaluation, visit our previous post on the topic.

After EVLA

As with any medical procedure, if you’ve undergone Endovenous Laser Ablation Therapy, or EVLA, it is important to know what to expect after the procedure— and to understand any recommendations or restrictions the doctor gives you.

Because EVLA is minimally invasive and almost always performed in an outpatient setting, there is usually minimal down time, if any. In most cases, those who undergo EVLA treatment can return to their regular daily activities immediately. In fact, many patients may return to work the day after your appointment, provided the job is not physically strenuous.

Recommendations

Immediately after the EVLA is performed, your leg will be washed and you will be asked to put on your compression stockings. Compression stockings should be worn for the first two weeks following treatment any time you are on your feet. (They do not need to be worn during sleep.) This is an important requirement and can make a big difference in your recovery.

Following EVLA, the treated leg may drain fluid for the first 24 hours, making the compression stocking feel damp. Patients can expect a moderate amount of bruising, swelling, and discomfort. Post-procedure discomfort is highly variable from patient to patient, and while some patients may experience pain, some may feel no discomfort at all following the procedure. Elevating your legs as much as possible, applying heat, and taking ibuprofen as needed are all effective ways to ease most post-operative pain.

Another important recommendation is to walk for 30 minutes each day for the first two weeks after your procedure. Walking can be done in short increments throughout the day adding up to 30 minutes, or it can be done all at once, whatever works best for your schedule.

Restrictions 

Post-procedure restrictions include no heavy lifting and no strenuous physical activity while standing. However, patients should feel free to exercise as long as their feet remain at, or above, the level of their heart (e.g. swimming or floor exercises, ideally with feet on an exercise ball).

The main reason for these restrictions is that those activities increase pressure by tightening the core or abdominal muscles— which then increases pressure downward into the legs. That pressure can cause irritation of the treated vein, which may lead to swelling. It's possile that the swelling could develop into phleblitis. The closed vein likely won’t open, but phlebitis can be quite uncomfortable.

Hot tubs are also restricted while you are healing. Even though doctors sometimes suggest patients use heating pads post-procedure, in a hot tub all of the veins in the legs above and below the treated area become dilated. This can actually cause pain.

           

Follow up

Finally, and most importantly: schedule a follow-up visit to the phlebologist within a week following the procedure to ensure that everything is healing properly. 

What is EVLA?

EVLA stands for endovenous laser ablation. For years, patients suffering from varicose veins and other effects of venous reflux had few options for treatment, among them vein stripping or ligation. Now, EVLA is considered the gold standard. 

During the outpatient procedure, the physician uses imaging guidance to thread a small laser fiber into the vein at the failure location. Laser energy is then applied to the inside of the vein, “irritating” the vein wall and essentially sealing the vein closed. The vein eventually disappears and is no longer visible on the surface of the leg. Blood is diverted to the many other healthy veins in the leg, and there are no ill effects from the loss of the troublesome vein. 

An appointment for EVLA therapy takes approximately two hours. The procedure itself usually takes about forty minutes. A local anesthetic is used, although for most patients, the laser causes no pain. You should tell your doctor if any pain does occur, so that more local anesthesia can be administered.

You may resume most normal activities immediately after the procedure, and most patients can return to work the next day. Note that many physicians require you to have someone drive you home, so be prepared to have someone accompany you to your appointment, or to meet you after your procedure is completed.

If you would like to learn more about EVLA and whether you are a good candidate for the procedure, call Dr. Cindy Asbjornsen at the Vein Healthcare Center. 

Happy veins, happy hearts

During the month of February, Americans tend to think a little more about their hearts, especially about what they can do to keep their arteries healthy. But arteries are just half of the story. 

Veins also need to be healthy to do their work optimally. (For a brief review of the circulatory system, check out our last post.)

While vein treatments today are outpatient procedures, minimally invasive and virtually pain-free, there ARE things one can do before seeing a doctor. 

Here are 3 ways to alleviate venous discomfort and help prevent the progression of symptoms:

• Walk. Walking causes the rhythmic contraction of calf muscles and helps promote blood flow to the heart. Walk at least 30 minutes every day– all at once, or in shorter increments.

• Elevate. Elevating your legs above your heart as often as possible– for as long as 30 minutes, or as briefly as three minutes. The best time is after you have been standing, or after a hot shower.

• Don’t smoke. Smoking and exposure to second-hand smoke constricts veins and affects overall circulation.

• Sit properly. Focus on good posture and avoid crossing your legs, or sitting in ways that can compress veins for prolonged periods.

Happy Valentine’s Day, and as always, feel free to give us a call at the Vein Healthcare Center with any vein-related questions you may have.

Veins and Heart Health

This month marks the 50th anniversary of American Heart Month. Did you know that veins play an important role in heart health?

Here's how. For twenty-four hours a day, the human circulatory system is continuously moving oxygen-rich blood to every cell in the body. While the arterial side of the system is well understood, we are still learning about many issues within the venous, or vein, system. 

The venous system contains approximately 70 percent of the body’s total blood volume when a person is at rest. Healthy veins carry blood from all extremities back to your heart, but when veins are compromised, it can affect your overall health and wellbeing.

Here’s a quick review of how the human heart works: 
The major parts of the circulatory system (also known as the cardiovascular system) are the heart, arteries and veins. Simply put, the heart pumps blood to the arteries, which take the oxygenated blood to all parts of the body. The veins take deoxygenated blood back up to the heart, where it is pumped directly to the lungs. In the lungs, carbon dioxide is replaced by oxygen, the renewed blood flows back to the heart, and the whole process begins again.

In the leg veins, blood is usually traveling against gravity, thus the valves in the leg veins perform an important function. Venous insufficiency, or vein disease, occurs if the valves in the veins become damaged and allow the backward flow of blood in the legs. This pooling of blood can lead to a feeling of heaviness and can cause skin changes such as “spider veins,” or a brown, woody appearance to the lower leg. Left untreated, it can lead to leg pain, swelling and serious health problems.

Venous disease is one of the most common health conditions in the United States. Many people have visible varicose veins, while others have no visible signs of the disease. It can affect men and women of all ages and activity levels, and while it has a strong genetic component, venous disease can be aggravated by environmental risks and other factors.

Achy, Heavy, Throbbing Legs? TV’s “The Doctors” Weigh in On Symptoms of Varicose Veins

In last week’s USA Weekend, “The Doctors”, known best for dispensing expert advice on their popular daytime TV show, explain why varicose veins are not just cosmetic and what you can do to prevent them.

From What You Can Do About Varicose Veins:

Start with lifestyle changes — exercising, elevating your legs and avoiding long periods of standing or sitting can help ease pain and keep veins from getting worse. In some cases, compression stockings may be needed to help with blood flow. For more severe varicose veins, there are a number of minimally invasive options that can fade or remove the vein; newer treatments use laser or radiofrequency to heat and close off the vein.

Read the full article.

Varicose Veins? Don’t Let Them Ruin Your Summer

Seasonal Tips for Healthy Legs

Summer is the perfect time to make sure you are doing everything you can to relieve symptoms of varicose veins and other vein problems. Varicose veins can worsen during the summer months, so if vein issues are keeping you from enjoying summer activities, making leg vein health a priority can help you take full advantage of the season.

Relief & Prevention Tips for Healthy Veins

• Stay as cool as possible. Heat dilates veins and causes pain and other symptoms to worsen.
• Swim and walk. Both exercises pump the calf muscles and improve circulation. 
• Wear graduated compression stockings. Wearing compression stockings all day will keep the legs feeling as good at the end of the day as in the morning.
• Stay hydrated. Drink plenty of water and other fluids.
• Elevate the legs whenever possible.
• Schedule an evaluation with a qualified phlebologist.
• Wear graduated compression stockings. Wearing compression stockings all day will keep the legs feeling as good at the end of the day as in the morning.

Don’t Wait Until Summer’s Over to Seek Treatment for Vein Issues

The treatments for venous problems are the same during the summer as the rest of the year.

Find out more about vein treatment options and keeping legs healthy by reading Dr. Cindy Asbjornsen’s Self-conscious About Unsightly Veins? Tips for Relief in the Bangor Daily News and leave concerns about leg vein issues behind this summer!