The spectrum of venous disease ranges from cosmetically displeasing spider veins all the way to chronically swollen ulcerated legs. The normal function of veins is to return blood from the body's tissues to the heart. Normally in the legs and arms, there are valve structures every several inches within the vein. These valves are designed to open to allow blood flow upward to the heart and to close and prevent the backflow of blood to the foot. When these valves function properly, blood pressure within the veins is actually quite low. Problems arise when the blood does not flow through the veins properly, resulting in abnormally high pressures. Abnormal blood flow in the veins may be the result of blockages (i.e., blood clot) or by leaky (incompetent) valves that allow reflux blood flow. Abnormally high pressure in the veins typically leads to swelling and discomfort, but may also result in additional changes such as skin discoloration; thickening of the skin and underlying tissue in the legs; the appearance of large spider veins near the ankle; or ulcerations in the leg.
In the leg, there are three systems of veins: superficial veins, right under the skin; deep veins located near the arteries and bones that carry 90 percent of the blood flow in the legs; and perforating veins that connect the two systems, generally carrying blood from the superficial veins inward toward the deep veins. Any of these systems, alone or in combination, can be afflicted by venous disease. Thorough diagnostic evaluation may include blood tests, ultrasound, CT scan, MRI, or a venogram, in which dye is injected into the veins and X-rays are taken.
Blood clots are fairly common, can arise due to a number of factors and are generally treated with blood thinning medications. These blood thinners can be given intravenously, through injections beneath the skin, or in pill form (e.g., Coumadin). Most blood clots resolve with blood thinning therapy, but clot resolution may result in damage to the delicate vein valves. Valve damage thereby allows the reflux of blood in the veins, contributing to abnormally high venous blood pressure.
The standard, more conservative treatment of venous disease combines external compression (e.g., elastic stockings) with leg elevation. However, a number of surgical options are also available, depending upon which venous system is involved. For example, the elimination of varicose veins is one option for treating superficial veins. If the perforating veins are involved, subfacial endoscopic perforator surgery (SEPS) is an option. Surgical options for deep veins include repairing vein valves, transplanting vein valves from a vein in the arm, or performing vein bypasses. For further information, please contact the Department of Vascular Surgery at 781-744-8577.