Written by Bryan Heart cardiologist, Timothy Gardner, MD, FACC
40 percent of people in the United States suffer from chronic venous insufficiency (CVI). This common disease is twice as prevalent as coronary artery disease and ten times as rampant as peripheral arterial disease.
Chronic Venous Insufficiency
CVI is caused when there is inadequate blood flow, yet abnormally high blood volume and pressure in the veins. This causes blood to pool in a person’s lower extremities, making it difficult to return to the heart. Which in-turn leads to venous hypertension, which causes plasma and red blood cells to leak through the vein walls into surrounding tissue.
Manifestations of venous disease include:
- Varicose veins
- Blood clots
- Inflammation or dermatitis
- Deep vein thrombosis (DVT)
- Limb loss
Although deep leg veins can be involved in venous disease, two veins called the great and lesser saphenous and perforator veins are the most common causative.
Diagnosis & Treatment
Diagnosis of venous disease is made by Venous Duplex Tilt Testing. This form of testing utilizes sound waves to detect blood clots in the veins. A transducer is placed on the skin and follows the waves. Images are then produced of the sound waves to show any presence of clots in the leg.
Treatment of venous disease to stop blood build-up in the legs involves either:
- Surgical removal of the vein (vein stripping)
Vein stripping is very painful and debilitating with a long recovery period.
Ablation, mainly radiofrequency ablation (RFA) supplies heat to the vein wall, removing the collagen and collapsing the vein. Successful RFA promotes reduction of varicose veins, swelling and healing of venous stasis dermatitis and venous ulcers, leading to a very satisfying outcome. This has become the treatment of choice for diseases such as chronic venous insufficiency and chronic venous hypertension.
With both techniques, blood from the vein is immediately rerouted to other better functioning veins.
Iliac Vein Lesion Syndrome
Iliac Vein Lesion Syndrome (IVLS) is compression of the lliac veins which causes Chronic Venous Hypertension even if there is no reflux of the veins in the legs. There can be significant obstruction of blood traveling to the heart causing all of the same clinical findings of CVI. IVLS causes 5% of all DVTs and also causes Pelvic Congestive Syndrome. IVLS should be considered when clinical findings are not explained by evaluation of the veins of the legs.
The gold standard of diagnosis and treatment is based on:
- lliac venogram
- Intravascular ultrasound
- Stent placement
Both genders and all ages, although predominantly those between 40 and 60 years of age, are affected by IVLS.
Successful Treatment for Venous Disease
Bryan Heart provides a full spectrum of treatment options for patients with venous disease. To refer a patient for evaluation and treatment as needed, call Bryan Heart at 402-483-3333.