Venous Conditions

Varicose Veins are prominent, large, tortuous leg veins and are an expression of venous infufficiency.  Varicose veins are not just an esthetic problem, they are often associated with symptoms such as:
  • Heaviness
  • Leg fatigue
  • Burning
  • Swelling
  • Cramping
  • Itching
  • Skin discoloration
  • Eczema
  • Ulcers

Varicose Veins can be treated by sclerotherapy and/or venous radiofrequency ablation.

Venous Ulcers
are skin openings due to improper functioning of superficial or deep lower extremity vein valves, which causes icreased pressure in the veins.  Venous ulcers develop most commonly in the medial ankle and can be very painful. Malfunctioning veins can be treated, thus reducing the risk of recurrent ulcers and speeding up the healing process. Significant improvement is obtained by frequent leg elevation, adequate leg compression by prescription hosiery, local wound care and, sometimes, specific medicated non-elastic bandages applied once/week by a healthcare professional (Unna Boot). Cases due to saphenous vein incompetence can be treated by venous radiofrequency ablation; those due to an incompetent perforator vein can be treated by foam sclerotherapy or radiofrequency ablation as well. Complicated cases of deep valvular incompetence may need skin grafting, or a deep venous reconstruction, which only a trained Vascular Surgeon is able to perform.

Deep Venous Thrombosis (DVT) means presence of a blood clot in a deep vein. The clot may block blood flow and cause swelling and pain of an extremity; it may also breaks off and move to the lungs (pulmonary embolism-PE, a potentially fatal condition). Risk factors for developing DVT are: prolonged bedrest, trauma, surgery, pregnancy and recent delivery, hearth failure, hormonal medications such as birth control pills (especially if associated with smoking), obesity, cancer, genetic predisposition, a previous DVT, long sitting while travelling. Diagnosis is made by urgent vascular ultrasound exam of the limb, and D-dimer, sometimes a CT-scan (rarely a nuclear scan) is performed to rule out a PE. Treatment consists of immediate administration of blood thinners, which sometimes can be done as an outpatients, other times needs hospital admission. Selected cases at risk for PE may need placement of an umbrella-like device in the vena cava through a minimally-invasive procedure, called inferior vena cava filter insertion. In other cases, reduction of the blood clot by catheter-directed thrombolysis (clot-busting medicine) mechanical thrombectomy may be indicated. Hospitalization, filter insertion and/or thrombolysis are services that can be provided by a Vascular Surgeon.

Post-thrombotic Syndrome. After an episode of DVT, often the veins are unable to get rid of the clot, and in the following weeks and months become scarred, narrowed, with non-functioning valves. This causes long-term swelling (edema) in the leg that had the deep vein thrombosis and, sometimes skin color changes, ulcers and pain to develop. Wearing compression stockings or a bandage prescribed by a healthcare provider significantly helps with the symptoms. More advanced cases which do not respond to conservative treatment may need a minimally invasive procedure, called deep venous stenting, which consists in the insertion of a meshed metal tube in the narrowed vein to keep it open.  A trained Vascular Surgeon is able to perform both procedures.