New Treatments for Vein Disorders

John Tomashek, M.D., Interventional Radiologist, Columbia St. Mary’s

Posted: Feb. 1, 2007

Although disorders of the veins are vastly different from those of the arteries, both are included within the realm of vascular disease. The veins are the blood vessels that carry the blood back toward the heart and lungs after the arteries have delivered the blood to the bodily organs. The most common venous disorders are nuisance spider veins, painful and disfiguring varicose veins, debilitating deep venous thrombosis (DVT) which is a clot in leg veins, and life-threatening pulmonary embolus (PE) which is a blood clot that has traveled to the lungs.

Significant chronic peripheral venous disease (commonly referred to as “venous insufficiency,” “venous hypertension” or “venous stasis”) affects at least one out of every four people. It affects both women and men, young and old, with little ethnic differences. Despite its prevalence, the treatment and study of venous disorders has in large part been viewed as an unimportant stepsister by the majority of the medical community for years. The unfortunate individuals afflicted with these stubborn disorders were once considered to have chronic, incurable problems.

Fortunately, there has been a revolution in how these patients are evaluated and treated. Over the past ten years, evolving science and technology has fostered treatment options for people with pain and swelling from the two main venous disorders of the legs: varicose veins and DVT.

Visible Venous Disease More Than a Cosmetic Problem
Varicose veins usually cause achy leg pain and swelling. People can also experience heaviness and tiredness in the affected leg(s), with leg cramps and burning sensations being less common complaints. In general, these symptoms are worse after patients have been on their feet or sitting in one position for some time. Leg elevation, use of compression stockings and avoiding standing typically improves symptoms.

If untreated, varicose veins will get worse, causing progressive leg pain and swelling. People can be plagued by episodes of phlebitis, when the veins temporarily clot becoming hard and tender. The increased pressure in engorged varicose veins can lead to permanent skin changes referred to as venous stasis dermatitis. With this, the skin of the shins and feet becomes dark, thick and hardened. The most dreaded complication is a venous stasis ulcer, where the pressure in the skin gets so high an open wound develops. The wound can last for months, often leaving scars. If the underlying veins are not addressed, the ulcer often recurs or progresses.

The long-term conditions from DVT are similar to those of varicose veins. Reports suggest that the incidence of chronic leg swelling and pain following occlusive DVT (referred to as post-thrombotic syndrome) can be as high as 50 percent. Quality of life studies have shown that as chronic venous disease progresses, physical health scores such as functional status and pain index deteriorate. Mental health scores tend to be affected as well.

Laser Treatment Alternative to Vein Stripping Surgery
In the past, vein stripping surgery was the treatment for varicose veins. Now, with aid of duplex ultrasound to precisely document the abnormal veins, targeted, minimally invasive interventions, such as ultrasound-guided endovenous laser ablation is an alternative for those people with symptomatic varicose veins.

Laser ablation is an outpatient treatment performed with local anesthetic. It involves placing a small laser fiber inside the abnormal vein. Heat from the laser causes the vein to close, rerouting the blood to normal veins. The treatment is at least as effective as surgery with less risk of complication. It also involves no stay in the hospital, less recovery time and has a lower chance of recurrence. This procedure has changed the climate so dramatically that many now consider conventional surgical vein stripping obsolete. In short, it’s an easier way to get rid of your varicose veins and get your life back.

Clot-Busters May Improve Outlook for People with Large DVT
Patients with DVT will have sudden onset of leg swelling and discomfort. The diagnosis is confirmed with an ultrasound of the deep leg veins. Immobility, hospitalization, age, obesity and concurrent illness (such as cancer) are associated with increased risk of developing DVT. Blood thinners remain the cornerstone of DVT therapy. Even with conventional therapy of blood thinners, people with massive DVT are at higher risk of pulmonary embolus and post thrombotic syndrome (chronic, severe leg swelling, pain and skin discoloration as a consequence of blocked leg and pelvis veins.) For these patients, catheter thrombolysis may be an option.

The procedure is simple. A small tube the size of a spaghetti noodle is placed into the clotted vein. Clot-dissolving medicine is delivered directly into the thrombus to melt it away. Dissolving the clot lessens the likelihood the patient will develop post thrombotic syndrome by limiting the damage to the vein wall and valves, therefore preserving its ability to function normally. Unfortunately, these large more symptomatic blood clots need to be identified early in order for thrombolysis to work. Thrombolytics work best for fresh clots less than 2 to 3 weeks old; beyond that time the clot causes irreparable damage and scarring to the vein lining and wall.

Vein problems are common, significant and often overlooked. But with medical advances, we are able to offer patients treatment options that not only treat their symptoms, but often eliminate the problem altogether.

John Tomashek, M.D.
Interventional Radiologist
Columbia St. Mary’s Vascular Institute
(414) 961-VASC

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