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Venous Therapies


 

In a sitting position, the patient's legs should be above the thighs:; supine, they should be above the level of the heart . the Unna boot, first described in 1854, is now a mainstay of treatment for people with venous ulcers. Unna boots are rolled bandages that contain a combination of calamine lotion, glycerin, zinc oxide, and gelatin. 

 

Sclerotherapy can be performed either with ultrasound guidance or light assistance. Both are safe and effective procedures that eliminate the need for traditional surgical removal of veins.
Light-assisted sclerotherapy is used to treat veins below the skin's surface that are difficult to see. These reticular veins are responsible for feeding the veins that are visible on the surface of the skin. During light-assisted sclerotherapy, a small, hand-held light illuminates the veins and tissue directly below the patient's skin. This allows the physician to clearly identify the source of the dysfunction and begin sclerotherapy.
Ultrasound-guided sclerotherapy is performed under the guidance of ultrasound. It is reserved for leaking veins that are not visible, and cannotbe seen with transcutaneous illumination (hand-held light used to view veins near the surface). This procedure is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in your leg) to the deep system ( veing under and between the muscles of the leg.) Perforator veins that leak and cause venous insufficiency can result in skin ulcers and must be treated at the source of the dysfunction. Due to their position along the artery, a skilled ultrasound sonographer is critical ro the success of this procedure.
Although this is a safe procedure, complications are possible. You should always do a thorough overview of risk and benefits with your physician prior to treatment. Also, clarify that your physician is using a modern sclerosant such as polidocanol, as some sclerosants used in the past were less comfortable upon injection and had worse side effects. Aditionally, confirm with your physician that the sclerosant is in liquid form, as opposed to foam. Foam sclerotherapy is the mixture of liquid and air prior to injection. Although foam sclerosant may be more effective, research is still preliminary and risks need to be further evaluated. Foam sclerotherapy treatment will likely receive FDA approval in the future, however, for now it is safest to confirm that your physician is using a liquid sclerosant alone. If you choose foam sclerotherapy, you should be fully informed about the known risks.
Ambulatory Phlembectomy
Ambulatory phlembectomy is a minimally invasive out-patient procedure used to treat varicose veins that are too large to be effectively treated with sclerotherapy. Ambulatory phlembectomy involves removing the vein through micro punctures in the skin. The defective vein is pulled to the surface of the skin and out of the leg through these small openings. Blood is diverted to the many other healthy veins in the leg; there is no ill effect from the loss of the vein.
This procedure lasts one to two hours and is performed under local anesthesia. No stitches are necessary in most instances, and the micro punctures are nearly imperceptible. Following the procedure, a bandage or compression stocking is worn for a short period of time, and patients can resume activity and return to their daily routine.
Endovenous Vein Treatments
Endovenous laser ablation (EVLA), also called endovenous laser therapy (EVLT) or radio frequency ablation (RFA), is a minimally invasive treatment used to address specific large varicose veins in the legs. It is considered the gold standard in treatment of venous symptoms, and has largely replaced previous, more invasive standards of care, such as vein stripping. EVLA has opened the door for many patients with venous disorders to eliminate symptoms and improve their apperance with minimal time investment and minimal pain.
EVLA is an outpatient procedure performed with local anesthetic. The procedure begins with the placement of an IV access port directly into the leaking vein. Prior to the placement of the IV, the skin is numbed with a small amount of anesthetic

 

You'll go to the hospital to get it done. Using an X-ray as a guide, a specialist will put a thin tube called a catheter into your vein and work the tip of it into your DVT. Then he'll use the catheter to send the drug directly into the clot.
If your vein seems narrow, he may widen it and help prevent future blockages by doing a balloon angioplasty or placing a stent. Surgery When taking blood thinners or clot-busting isn't possible or doesn't work well, your doctor may want to try a more involved procedure. Vena cava filter.
This small metal device catches blood clots and stops them from moving to parts of your body where they can become dangerous. Blood passes through the filter normally.
It goes in the vena cava, the main vein that takes blood from your lower body back to your heart. Your doctor will put the filter into
Today's Treatments are Reaching New People
The treatment of venous diseases today is vastly different from traditional treatments performed in the past. Breakthroughs in minimally invasive treatment and the many effective out-patient procedures available are providing more people immediate relief from their venous disease symptoms.
These new approaches to treatment involve less time and less pain, and they are overwhelmingly successful over the long term when performed by an experienced phlebologist. People no longer have to live with pain, discomfort, or embarrassment. By treating the symptoms, people have stopped the progression of their disease and improved their quality of life.
Comprehensive Care From a Trained Phlebologist
It is critical that venous disorders be treated appropriately by a vein specialist ( also called a phlebologist). Despite the ease of today's modern treatments, the source of the problem and how one's overall health is affected must be considered a part of patient care.
During an initial visit to the Vein Healthcare Center, a trained vein specialist uses "ultrasound mapping" to diagnose the patient. Ultrasound mapping uses high-frequency sound waves to create images that form a map of the venous system. This map is used to determine the individual's pattern of diseased veins and to indentify the source of insufficiency so effective treatment can begin.
Treatment options
Sclerotherapy
Sclerotherapy is used to treat veins just below the skin's surface that are either invisible or difficult ro see with the naked eye. In this procedure, small needles provide access to the vein so a medicine called a sclerosing agent can be injected into the vein's interior wall. This substance causes the vein to become sticky and seal shit, allowing the vein to dissapear. Blood then finds a healthy path back to the heart. There is little risk of complication, and patients often experience an immediate relief of symptoms.

Blood Thinners
These drugs, also called anticoagulants, are the most common treatment for DVT. They can keep a clot from growing or breaking off, and they prevent new clots from forming. But they cant thin your blood, despite their name, or dissolve an existing clot.
Blood thinnes inclue:
• Apixaban (Eliquis) • Dabigatran (Pradaxa) • Edoxaban (Savaysa) • Fondaparinux (Arixtra) • Heparin • Rivaroxaban (Xarelto) • Warfarin (Coumadin)
In the hospital, your doctor may give you heparin at first, by needle into your vein or as a shot. You may have to keep taking shots at home, once or twice daily. When you take heparin by IV, you'll need blood tests, too. But you won't need them when you're taking shots of low-molecular-weight heparin under your skin.
You may take warfarin (Coumadin) by pill once a day, starting while you're still on heparin, and then usually for 3 to 6 months or more. While you take it, you'll need regular blood tests to make sure you've got the right amount in your system — too little won't prevent clots, too much makes dangerous bleeding more likely. It can also interact with other medicines, vitamins, and foods with a lot of vitamin K, which is another good reason to get your blood checked often.
Let your doctor know if you're pregnant, because warfarin can cause birth defects. You'll have to take something else.
Newer anti-clotting medicines, known as Xa inhibitors, work as well as warfarin for most people. You won't have to get blood tests, change your dose, or remember what foods you ate. These drugs may cause less bleeding than warfarin, but there's no medicine you can take to stop bleeding if it becomes a problem.
Apixaban, edoxaban, and rivaroxaban are all pills. Fondaparinux is a shot that people who are having hip fractures, hip replacement, knee replacement, or abdominal surgery get to prevent DVT. Your doctor might also prescribe it with warfarin to treat a serious DVT, or to treat a clot that gets stuck in your lung, called a pulmonary embolism.
Dabigatran is a pill that stops a specific protien that helps your blood clot from working. That's why it's called a direct thrombin inhibitor.
Clot-Busting: Catheter-Directed Thrombolysis
Your body will dissolve the blood clot eventually, but in the meantime, it could damage the inside of your vein. Your doctor may recommend a clot-busting medicine called a thrombolytic agent if you:
• Have large clots causing pain, swelling, and problems with circulation • Are at high risk for a pulmonary embolism • Have DV in your arm, rather than your leg
This procedure quickly breaks up a clot and restores blood flow. It may also save the valves in that vein. But it's riskier than taking blood thinners. You have a greater chance of bleeding problems and stroke.

You may experience certain side effects after sclerotherapy. There are milder effects, such as itching, which can last for one to two days after the procedure. Also, you may experience raised, red areas at the injection site. These should disappear within a few days. Bruising may also occur around the injection site and can last several days or weeks.
Other Sclerotherapy Side Effects Include:
• Larger veins that have been injected may become lumpy and hard and may require several months to dissolve and fade. • Brown lines or spots may appear at the vein site. In most cases, they disappear within three to six months, but they may also last indefinitely. • Neovasculatization —the development of new, tiny blood vessels — may occur at the site of sclerotherapy treatment. These tiny veins can appear days or weeks after the procedure, but should fade within three to twelve months without further treatment.
Graduated Compression and Other Physical Therapy
The standard approach has been to use gradient compression stockings that provide 30-40 or 40-50 mm Hg of compression at the ankle, with gradually decreasing compression at more proximal levels of the leg. This amount of graduated compressioin is sufficient to restore normal venous flow patterns in many or most patients with superficial venous reflux and to improve venous flow, even in patients with severe deep venous incompetence.
The compression gradient is extremely important because nongradient stockings or high-stretch elastic bandages (eg, ACE wraps) may cause a tourniquet effect that can exacerbate the venous insufficiency. The so-called antiembolic stockings that are commonly available in American hospitals do not provide sufficient compression to improve the venous return from the legs, and they are not particularly effective in preventing venous thromboembolism.
No patient with symptoms due to venous insufficiency should be without gradient compression hose, which can be prescribed by any physican. The prescription should specify 1 pair of calf-high (or thigh-high with waist attachment or panty-hose style) compression hose providing a pressure gradient of 30-40 mm Hg, with refills as needed.
Additional physical measures may also be helpful. Leg elevation causes venous flow to be augmented by gravity, lowering venous pressures and
Treatment for Deep Vein Thrombosis (DVT)
What will treating DVT, a blood clot deep in a vein, do for you?
• It will prevent the clot from growing. • It'll keep the clot from breaking off and traveling to your lung or another organ. • You'll avoid long-lasting complications, such as leg pain and swelling. • Treatment prevents future blood clots, too.
Often, medication and taking care of yourself will do the trick. But you may need surgery. Talk to your doctor about which medical treatment options are right for you.

 

Progression of thrombus from local superficial phlebitis has occasionally been obseved when compression was not used.
Follow-up Care
Compression is of vital importance after an procedure. Compression is effective in reducing postoperative bruising and tenderness, and it can also reduce the risk of venous thromboembolism in both the treated leg and the untreated leg.
A class II (30- to 40- mm Hg gradient) compression stockin is applied to the treated leg, and, if the patient is willing, it is also applied to the untreated leg. Bed rest and lifting of heavy objects are forbidden, and normal activity is encouraged.
The patient is reevaluated 3-7 days after the operation, at which time duplex ultrasonography should demonstrate a closed greater saphenous vein and no evidence of thrombus in the femoral, popliteal, or deep veins of the calf.
At 6 weeks, an examination should reveal clinical resolution of truncal varices, and an ultrasonographic evaluation should demonstrate a completely closed vessel and no remaining reflux. If any residual open segments are noted, sclerotherapy is performed under ultrasonographic guidance.
Sclerotherapy
Sclerotherapy is a medical procedure used to eliminate varicose veins and spider veins. Sclerotherapy involves an injection of a solution ( generally a salt solution) directly into the vein. The solution irritates the lining of the blood vessel, causing it to collapse and stick together and the blood to clot. Over time, the vessel turns into scar tissue that fades from view.
Sclerotherapy is a proven procedure that has been in use since the 1930's.
How Sclerotherapy Is Done
In most cases of sclerotherapy, the salt solution is injected through a very fine needle directly into the vein. At this point, you may experience mild discomfort and cramping for one to two minutes, especially when larger veins are injected. The procedure itself takes approximately 15 to 30 minutes.
The number of veins injected in one session depends on the size and location of the veins, as well as the general medical condition of the patient.
Sclerotherapy is performed in the doctor's office by a dermatologist or a surgeon and requires that you do not do any aerobic activity for a few days after the procedure.
What to Do Before Sclerotherapy
Prior to sclerotherapy, you should avoid certain medications. Talk to your doctor about all medicines (including over-the-counter drugs, herbs, and dietary supplements) you are taking. If you need to take an antibiotic before sclerotherapy, contact your doctor. No lotion should be applied to the legs before the procedure.
Some doctors recommend avoiding aspirin, ibuprofen (such as Advil, Motrin, and Nuprin) or other anti-inflammator drugs for 48-72 hours before sclerotherapy. Tylenol, however, should not affect this procedure.
Side Effects of Sclerotherapy

 

• Stab evulsion (with or without ligation) • Radiofrequency ablation (RFA) • Endovenous laser therapy (EVLT)
All methods of venoablation are effective (although there is some disagreement between the medical and the surgical literature as to the prevalence and timing of varicose recurrences.) Once the overall volume of venous reflux is reduced below a critical threshold by any mechanism, venous ulcerations heal, and patient symptoms are resolved.
In general, vein ligation is reserved for cases of chronic venous insufficiency (CVI) involving reflux in the saphenous sytem that causes severe symptoms. Thus, a diagnosis of reflux must be established preoperatively, usually with photoplethysmography or duplex imaging. [Contraindications] In patients with symptomatic varicosities of the great saphenous vein (GSV), deep occlusion must be ruled out; it is an absolute contraindication to vein ligation. Venography of the deep venous system before superficial vein ligation is imperative.
Sclerotherapy is performed by injecting or infusing a sclerosing substance into the refluxing vessel to produce endothelial destruction and fibrosis of the treated vessel. Injection of a sclerosing agent directly into veins usually is reserved for telangiectatic lesions rather than CVI. Phlebotonics have not been proven to be beneficial for CVI.
In the historical surgical approach, ligation and division of the saphenous trunk and all proximal tributaries are followed either by stripping of the vein or by avulsion phlebectomy. Proximal ligation requires a substantial incision at the groin crease. Stripping of the vein requires additional incisions at the knee or below and is associated with a high incidence of minor surgical complications. Avulsion phlebectomy requires multiple 2- to 3-mm incisions along the course of the vein and can cause damage to adjacent nerves and lymphatic vessels.
EVLT is performed by passing a laser fiber from the knee to thr groin and then delivering laser energy along the entire coure of the vein. Destruction of the vascular wall is followed by fibrosis of the treated vessel. It has been shown to yield excellent long-term (>5 years) results and a low rate of complications, which vary with the laser wavelength used.
RFA is perfomed by passing a special radiofrequency (RF) catheter from the knee to the groin and then carrying out controlled and preset heating of the targeted vessel until thermal injury causes shrinkage. The process is repeated every 7cm along the course of the vein. Initial thermal injury is followed by fibrosis of the treated vessel. RFA has been shown to be effective, with a low rate of complications. It has produced excellent results that have been confirmed with up to 10 years of follow-up.
Outcomes
Published results show a high early success rate with a very low subsequent recurrence rate up to 10 years after treatment. Early and mild range results are comparable to those obtained with other endovenous ablation techniques. The authors' overall experience has been a 90% success rate, with rare patients requiring a repeat procedure in 6-12 months. Overall efficacy and lower morbidity have resulted in endovenous ablation techniques replacing surgical stripping.
Patient satisfaction is high and downtime is minimal, with 95% of patients reporting they would recommend the procedure to a friend.
Complications
Reported complications of the procedure are rare. Local paresthesias can occur from perivenous nerve injury but are usually temporary. Thermal injury to the skin was reported in clinical trials when the volume of local anesthetic was not sufficient to provide a buffer between skin and a particularly superficial vessel, especially below the knee.

 

No oral medication has yet been proven useful for the treatment of venous disease. Graduated compression is the cornerstone of the modern treatment of venous insufficiency. Surgical or endovenous therapy is commonly reserved for those with discomfort or ulcers refractory to medical management. The primary goal of such therapy is to improve the venous circulation by correcting venous insufficiency by removing the majr reflux pathways.
As yet, no treatment for deep venous insufficiency has been proved to be both safe and effective. Valvulopsty is occasionally successful, but the incidence of postoperative deep venous thrombsis (DVT) is high. Venous bypass is successful in select patients. External vein valve banding devices and thermally induced collagen shrinkage procedures are being investigated in clinical trials. Restoration of valvular function to incompetent deep veins remains an important focus of research for vascular physicians.
Although deep system disease is often refractory to treatment, superficial system disease can usually be treated by ablating the refluxing vessels. Refluxing superficial vessels can safely be removed or ablated without sequelae; an incompetant vessel has already proved itself unnecessary because it is carrying venous blood in a retrograde direction. Antibiotics rarely are useful in patients with venous ulcerations.
Risk factors for varicose veins are:
• Genetic disposition (history of varicose veins in the family) • Gender (1 out of 3 women and 1 out of 5 men are affected) • Pregnancy (30% of women will develop varicose veins during the first pregnancy, and 55% will during the second and following pregnancies) • Age( people older than 50, as older people are more susceptible to develop varicose veins)
Risk factors for chronic venous insufficiency are:
• Professions requiring prolonged standing or sitting • Gender (women develop edema more often) • Obesity (CV! may develop even without reflux or obstruction in the veins) • Age (older people are more susceptible to develop venous disease)
Can we cure venous disease?
Defective venous valves of varicose veins cannot be replaced or fixed. Superficial venous refluxes can be repaired by surgical removal or sclerotherapy of the varicose vein(s). Howeveer, chronic venous disease due to deep venous incompetence — such as in post-thrombotic syndrome — can only be treated by valve repair or neo-valve construction in isolated cases.
Chronic venous disease evolves with time. The therapy consists of methods that help to reduce the "ambulatory venous hypertension." Phlembologists, physicians specialized in veno-lymphatic diseases, all agree that compression stockings are THE basic treatment of venous disease. This is the reason why medical compression stockings are recognized as a medicine.
Venoablation
Venoablation is reserved for those with discomfort or ulcers refractory to medical management. The primary goal of surgical and endovenous approaches is to correct venous insufficiciency by removing the major reflux pathways. Techniques for venoablation include the following:
• Ligation with stripping • Simple ligation and division • Sclerotherapy (with or without ligation)

 

This treatment method is generally reserved for advanced venous insufficiency. In scleropathy, a chemical is injected into the damaged vein so that it is no longer able to carry blood. Blood will return to the hearth through other veins, and the damaged vein will eventually be absorbed by the body. Sclerotherapy is used to destroy small to medium veins. A chemical is injected into the damaged vein so that it is no longer able to carry blood.
Catheter Procedures
In severe cases, your doctor can use a catheter procedure for larger veins. They'll insert a catheter ( a thin tube) into the vein, heat the end of it, and then remove it. The heat will cause the vein to close and seal as the catheter is taken out.
Venous Insufficiency Overview
Venous insufficiency resulting from superficial reflux because of varicose veins is a serious problem that usually progresses inexorably if left untreated. When the refluxing circuit involves failure of the primary valves at the saphenofemoral junction, treatment options for the patient are limited, and early recurrences are the rule rather than the exception.
What are Venous diseases?
In patients with venous disease, the internal walls of the leg veins are deteriorated and the small valves are defective and incompetent. When a valve is incompetent, either in the deep or superficial vein system, blood flows backwards towards the foot. This is called reflux. When valves are incompetent in the superficial veins only, the deep veins have to carry more blood towards the heart. To compensate, the veins expand and the valves may not close properly. When this happens, such as in the case of servere varicose veins, the deep vein system may also become incompetent. When blood is no longer pumped effictively from from the lower leg, the peripheral veins will not be emptied even when walking. They remain filled with blood and the pressure in vein will not decrease. This condition is known as chronic venous insufficiency (CVO which may result in edema, skin change and in some cases ulcerations.
Varicose veins are gnarled. Enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins of your lower body.
For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.
Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins. Approach Considerations Venous insufficiency is neither uncommon nor beign.treatment is aimed at ameliorating the symptoms and, whenever possible, at correcting the underlying abnormality.
No oral medication has yet been proven useful for the treatment of venous disease. Graduated compression is the cornerstone of the modern treatment of venous insufficiency. Surgical or endovenous therapy is commonly reserved for those with discomfort or ulcers refractory to medical management. The primary goal of such therapy is to improve the venous circulation by correcting venous inssuficiency by removing the major reflux pathways.

 

• Tight feeling calves or itchy painful legs
Chronic venous insufficiency treatment may include:
• Measures to improve blood flow in the leg veins. Methods to help increase blood flow in leg veins include elevating the legs to reduce pressure in the leg veins and compression stockings to apply pressure on the legs and help blood flow. Other methods include keeping the legs uncrossed when sitting and reagular exercise. • Medications. Diurectics (medications used to draw excess fluid from the body through the kidneys) should typically not be used unless there are other separate conditions such as heart failure or kidney disease that are also contributributing to the swelling. Medications that improve the flow of blood through the vessels may be used in combination with compression therapy to help heal leg ulcers. Aspririn can also be used to help ulcers heal. • Sclerotherapy. For patients whose condition is more advances, sclerotherapy may be prescribed. This involves injecting a chemical into the affected veins. The chemical causes scarring in the veins and the body absorbs the scarred veins. • Surgery. Surgery is recommended in fewer than 10% of people with chronic venous insufficiency. Surgical procedures that may be used to treat the condition include: o Ligation. This procedure involves tying off an affected vein so that blood no longer flows though it. If the vein and/or its values are heavily damaged, the vein will be removed ('vein stripping"). o Surgical repair. A vein and/or valves may be surgically repaired, either through an open incision or with the use of a long catheter (hollow tube). o Vein transplant. This involves transplanting a healthy vein from another body area and replacing the diseased vein with the healthy vein. o Subfascial endoscopic perforator surgery. A minimally-invasive procedure performed with an endoscope (a small, flexible tube with a light and a lens on the end). The perforator veins ( veins found in the calf area) are clipped and
Surgery
Sometimes more serious cases of venous insufficiency require surgery. Your doctore may suggest one of the following types:
• Surgical repair of veins or valves • Removing (stripping) the damaged vein • Minimally invasive endoscopic surgery—the surgeon inserts a thin tube with a camera on it to help see and tie off varicose veins • Vein bypass (a healthy vein is transplanted from somewhere else in your body) — this procedure is generally used only when the upper thigh is affected and only for very severe cases after nothing else has worked. • Laser surgery — this relatively new treatment uses lasers to either fade or close the damaged vein with strong surges of light in a small, specific place. It involves no surgical cuts.
Ambulatory Phlebectomy
This outpatient procedure (you wont have to spend the night at the hospital) involves your doctor numbing certain spots on your leg, then making small pricks and removing smaller varicose veins.
Sclerotherapy

 

• Exercise regularly Medications There are also a number of medications that may help those suffering from this condition. These include:
• Diuretics: medications that draw extra fluid from your body through your kidneys. • Anticoagulants: medications that thin the blood How to Prevent Venous Insufficiency If you have a family history of venous insufficiency, there are steps you can take to lessen your chances of developing the condition:
• Don't sit or stand in one position for long stretches of time — get up and move around frequently. • Don't smoke and if you do smoke, quit. • Get regular exercise. • Maintain a healthy body weight.
What is chronic venous insufficiency?
Chronic venous insufficiency occurs when the leg veins do not allow blood to travel back to the heart. (Arteries carry blood away from the heart, while veins carry blood to the heart). Problems with the valves in the veins can cause the blood to flow in both directions, not just towards the heart. These valves that are not working properly can cause blood in the legs to pool. If chronic venous insufficiency is left untreated, pain, swelling, and leg ulcers may result.
Chronic venous insufficiency does not pose a seriuos health threat, but the condition can be disabling and cause pain.
What cause chronic venous insufficiency?
Chronic venous insufficiency is more common among those who are obese, pregnant, or who have a family history of the problem. Individuals who have had trauma to the leg through injury, surgery, or previous blood clots are also more likely to develop the condition.
Other causes of chronic venous insufficiency include, but are not limited to, the following:
• High blood pressure in the leg veins over a long time, due to sitting or standing for prolonged periods • Lack of exercise • Smoking • Deep vein thrombosis ( a blood clot in a deep vein, usually in the calf or thigh) • Phlebitis (swelling and inflammation of a superficial vein, usually in the legs)
What are the symptoms of chronic venous insufficiency? Symptoms of chronic venous insufficiency may include: • Swelling in legs and/or ankles

 

Venous insufficiency is more common in women than in men. According to The University of Chicago Medical Center, it's also more likely to occur in women between 40 and 49 and in men between 70 and 79. Other risk factors include:
• Blood clots • Varicose veins • Obesity • Pregnancy • Smoking • Cancer • Muscle weakness, leg injury, or trauma • Swelling of a superficial vein (phlebitis) • Family history of venous insufficiency • Inactivity (sitting or standing for long periods of time without moving can cause high blood pressure in the leg veins and increase your risk)
Venogram
During a venogram, your doctor will put an intravenous (IV) contrast dye into your veins. Contrast dye causes the blood vessels to appear opaque on the X-ray image, which helps the doctor see them on the image. This dye will provide your doctor with a clearer X-ray picture of your blood vessels.
Duplex Ultrasound
A type of test called a duplex ultrasound may be used to test the speed and direction of blood flow in the veins. 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.
How Venous Insufficiency is Treated
Treatment will depend on many factors, including the reason for the condition and your health status and history. Other factors your doctor will consider are:
• Your specific symptoms • Your age • The severity of your condition • How well you can tolerate medications or procedures
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.
Treatment for venous insufficiency can include several different strategies: Improving Blood Flow Some tips to improve your blood flow include:
• Keep your legs elevated whenever possible • Wear compression stockings to apply pressure to lower legs • Keep your legs uncrossed when seated

 

What is Venous insufficiency?
Venous insufficiency is a condition where the flow of blood through the veins is inadequate, causing blood to pool in the legs. It can be caused by several different vein disorders, but it's most often caused by either blood clots varicose veins. Your treatment options depend on what's causing the condition, but your doctor might recommend compression stockings and prescription medications. In more serious cases, you may need surgery.
Your arteries carry blood from your heart out to the rest of your body. Your veins carry blood back to the heart, and the valves in the veins stop the blood from flowing backward. When your veins have trouble sending blood from your limbs to the heart, it's known as venous insufficiency. In this condition, blood doesn't flow back properly to the heart, causing blood to pool in the veins in your legs.
Several factors can cause venous insufficiency, though it's most commonly caused by blood clots (deep vein thrombosis) and varicose veins. Even if you have a family history of venous insufficiency, there are simple steps you can take to lower your chances of developing the condition.
Symptoms of Venous Insufficiency
Symptoms of Venous insufficiency include:
• 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
How is Venous Insufficiency Diagnosed?
Your doctor will want to do a physical examination and take a complete medical history to figure out if you have venous insufficiency. They may also order some imaging tests to pinpoint the source of the problem. These tests may include a venogram or a duplex ultrasound.
Causes of Venous Insufficiency
Venous insufficiency is most often caused by either blood clots or varicose veins. In healthy veins, there is a continuous flow of blood from the limbs back toward the heart. Valves within the veins of the legs help prevent the backflow of blood.
The most common causes of venous insufficiency are previous cases of blood clots and varicose veins. When forward flow through the veins is obstructed — such as in the case of a blood clot — blood builds up below the clot, which can lead to venous insufficiency. In varicose veins, the valves are missing or impaired and blood leaks back through the damaged valves. In some cases, weakness in the leg muscles that squeeze blood forward can also contribute to venous insufficiency.

 

Why it's done
Your body's tissues need an adequate supply of oxygen to function. When tissue is injured, it requires even more oxygen to survive. Hyperbaric oxygen therapy increases the amount of oxygen your blood can carry. An increase in blood oxygen temporarily restores normal levels of blood gases and tissue function to promote healing and fight infection.
Hyperbaric oxygen therapy is used to treat several medical conditions. And medical institutions use it in different ways. Your doctor may suggest hyperbaric oxygen therapy if you have one of the following conditions:
• Anemia, severe • Brain abscess • Bubbles of air in your blood vessels ( arterial gas embolism) • Burn • Decompression sickness • Carbon monoxide poisoning • Crushing injury • Deafness, sudden • Gangrene • Infection of the skin or bone that causes tissue death • Nonhealing wounds, such as a diabetic foot ulcer • Radiation injury • Skin graft or skin flap at risk of tissue death • Vision loss, sudden and painless
Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. Hyperbaric oxygen therapy is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with hyperbaric oxygen therapy include serious infections, bubbles in your blood vessels, and wounds that won't heal as a result of diabetes or radiation injury.
In a hyperbaric oxygen therapy chamber, the air pressure is increased to three times higher than normal air pressure. Under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure.
Your blood carries this oxygen throughout your body. This helps fight bacteria and stimulate the release of substances called growth factors and stem cells which promote healing.
Risks
Hyperbaric oxygen therapy is generally a safe procedure. Complications are rare. But this treatment does carry some risk.
Potential risks include:
• Temporary nearsightedness (myopia) caused by temporary eye lens changes • Middle ear injuries, including leaking fluid and eardrum rupture, due to increased air pressure • Lung collapse caused by air pressure change (barotrauma) • Seizures as a result of too much oxygen ( oxygen toxicity) in your central nervous system • In certain circumstances, fire—due to the oxygen-rich environment of the treatment chamber

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