VENOUS DISORDERS

Venous disorders include chronic and acute problems.. They cover a wide range of symptoms from the most serious blood clots that threaten our very lives to non-threatening cosmetic blemishes found in the majority of the population. Chronic venous disorders are very frequent; they affect at least 20% of the entire adult population and over 50% of females over 60 years of age. Acute blood clots occur in 2 million Americans each year.

Chronic Venous Disorders:

The enormous advances in diagnosis and treatment of the past few years make the management of vein problems precise and patient-friendly. The wonders of ultrasound-painless imaging of the veins, non-invasive, affordable, accurate-make it possible to actually see the veins under the skin and test their function just by placing jelly and a light probe connected to a computer on the skin. The information is so precise that other methods of diagnosis now play a secondary role. In addition, advances in minimally-invasive endovascular catheter treatment methods and innovations in special techniques of injection procedures allow effective treatment of 9 out of 10 vein problems. This is done in the office setting with minimal discomfort and almost zero loss of time from normal activity.

In the management of venous disorders the oldest form of treatment is to provide support to the leg's tissues by bandaging, or by use of compression stockings. This remains an extremely important basic tool for the management of both acute and chronic vein problems and is prescribed extensively at the KVC. The effective use of these supports is associated with all of the treatments described for the lower extremity veins and lymphatics.

In the spectrum of chronic venous disease spider veins are the least serious and the most frequent problem. They cause mainly cosmetic discomfort. Varicose veins are much more serious since they frequently cause persistent discomfort and swelling and produce a measurable effect on the individual's quality of life. The advanced complications of skin changes from neglected varicose veins result in discoloration, thickening, and non-healing ulcers (sores) in the skin of the lower legs. These changes occur in about 20% of cases of long standing varicose veins and are largely preventable by early treatment of the varicose veins.

The progressive nature of these problems is illustrated as follows:

Spider veins-->--Varicose veins-->--Skin changes-->--Ulceration


Spider Veins

Varicose Veins

Skin Changes

Venous Ulcers

Treatment is individualized in the Kistner Vein Clinic to the simplest effective method appropriate to the diagnosed problem. These treatments can be done with near immediate return to customary activity for most cases.

Acute Venous Disorders:

Acute vein disease consists mainly of blood clots (phlebitis) and their complications. A blood clot in the leg should be suspected when there is swelling or pain in one leg that does not have an obvious cause, such as an injury. Such an occurrence is best investigated with an ultrasound examination, called a 'duplex scan'. These are painless and affordable tests that are widely available in hospitals and emergency rooms and specialty offices.

The emphasis should be on making the diagnosis early (within 3-5 days) because immediate effective medication can stop the clotting process. This will prevent both short and long term complications from the clot. Untreated blood clots in the deep veins of the leg often travel to the lungs where they are a threat to life in the short term, and produce lifelong damage to the leg veins that causes swelling and disability in the long term.

Treatment of blood clots with newer anticoagulant medications can be done in the majority of cases on an outpatient basis. Effective treatment requires careful follow up to confirm the clotting process has been stopped to prevent new clots from forming and to prevent serious complications.