By E J Sanchez, MD, FACC
In our lifetime, all of us will experience some form of leg pain typically attributed to joint or muscle fatigue and arthritis. But did you know that the most common leg pain is caused by venous insufficiency regardless of whether or not you have obvious unsightly veins (varicose veins or spider veins)?
Our cardiovascular system moves blood from the heart through the arteries into the organs, hence the term cardiovascular. Cardio refers to the heart and vascular refers to the arteries, but there is also a system responsible for returning the blood to the heart from these organs and muscles – the venous system. Unlike the cardiovascular system, which has a powerful heart pumping blood through it, the venous system depends on a more passive movement of blood utilizing the peripheral muscles in the body. In our legs, the calf and thigh muscles are most responsible for contributing to the movement of blood through the venous system into the heart. To allow this process to occur, the venous system has multiple valves throughout. When a failure of these valves or assisting muscles occurs, often times the backward blood flow forms spider veins or dilated veins, which appear ropy on the skin. This is venous insufficiency.
Venous insufficiency treatment starts conservatively with exercise, compression therapy (stockings), and use of an over the counter anti-inflammatory. When conservative treatment fails or when there is continuous spontaneous bleeding or failure of venous ulcers to heal, treating the superficial venous system, especially the incompetent varicose veins, will bring relief to the patient by moving most of the blood flow in the deep veins, which are less likely to become incompetent.
Historically, the treatment of varicose veins and venous disease consisted of surgical procedures known as stripping of the vein. This procedure has fallen out of favor for two primary reasons. The first is the use of general anesthesia which equates to a prolonged recovery. The second is that there is a higher incidence of blood clots and recurrent of varicosities after the procedure. Since the late 1990s, other less invasive procedures have been developed. These procedures include ultrasound-guided sclerotherapy performed through an injection or radiofrequency, and laser endovenous closure or ablation. These procedures are proven to be safe and do not require general anesthesia or a prolonged hospital stay. The success rate and lack of recurrence is much greater. Additionally, a modality called ambulatory micro phlebectomy, a procedure in which the veins are moved through a needle sized hole, not needing stitching and avoiding also prolonged recoveries, may also be an effective treatment.
All of these procedures are done in the office and the patients usually return to work the next day.
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