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| BACKGROUND | DIAGNOSIS | TREATMENT | SURGERY |
GLOSSARY OF TERMS
In the arms and legs there are three major types of veins:
Superficial veins are near the surface of the skin and often visible.
Deep veins are located near the bones and are surrounded by muscle.
Connecting the deep and superficial veins are the Perforator veins.
Deep Vein Thrombosis (DVT) is a condition marked by the formation of a blood clot (thrombus) within a deep vein (as of the leg or pelvis) that remains attached to its place of origin on the vessel wall.
DVT may be asymptomatic or be accompanied by symptoms (as swelling and pain) and that is potentially life threatening if dislodgment of the thrombus results in Pulmonary Embolism.
Pulmonary Embolism (PE) is a sudden obstruction of a pulmonary artery or one of its branches by an embolus, an abnormal particle (as a piece of cholesterol, calcium or blood clot, or air bubble) circulating in the blood that hinders blood flow. The embolus is most often a blood clot originating in a vein of the leg or pelvis.
PE is marked by labored breathing, chest pain, fainting, rapid heart rate, cyanosis, shock, and sometimes death
Homocysteine is an amino acid found in the plasma of the blood, high levels are associated with vascular disease.
Erythrocytosis is a dramatic increase in the number of circulating red blood cells.
Thrombocytosis is an abnormal increase in the number of blood platelets.
Chronic Venous Insufficiency (CVI) is a condition in which blood does not flow normally through the veins from the feet back up towards the heart.
CVI can be caused by damaged valves in the veins or vein blockage. Both conditions may be a result of Deep Vein Thrombosis (DVT) – blood clots in the deep veins of the legs.
Non-healing ulcers: The area where the blood accumulates causes the vessel wall of the vein to break down and then the surrounding tissue tends to break down as well. Eventually, a visible ulcer develops on the skin. If left untreated, these ulcers can quickly become infected and even gangrenous.
BACKGROUND
MECHANISM
In the legs blood flow in the veins must progress upwards, against the force of gravity. To overcome this, the veins contain a series of specialised one-way valves that open to allow the blood to flow upward, and then shut to keep the blood from flowing back downwards toward the feet.
When the valves in the veins do not function properly, the blood leaks backward and stagnates in the veins of the lower legs. This in turn increases the blood pressure in the leg veins and causes them to stretch and dilate and form either Varicose Veins, Spider Veins, or Reticular Veins.
Varicose Veins are enlarged, bulging superficial veins that can be felt beneath the skin, generally larger than 3-mm in diameter. They are most often found on the back of the calf or on the inside of the leg or groin area.
Spider Veins are tiny dilated veins, usually less than 1-mm in diameter, located in the surface skin layer. Spider veins cannot be felt.
Veins larger than spider veins, but still under 3-mm are called Reticular Veins.
CAUSE
Varicose veins are caused by valve deterioration in the veins of the legs. Varicose veins can develop as a result of an inherent weakness in the wall of the vein or Deep Vein Thrombosis (DVT).
PATIENT PROFILE
Varicose veins occur more frequently in women than in men. Factors that increase the pressure on the legs can lead to the development of varicose veins. People who are overweight or spend much of their day standing are at increased risk of developing varicose veins. Increasing age, heavy lifting, and multiple pregnancies are also risk factors for developing varicose veins.
SYMPTOMS
Varicose veins may be entirely symptom-free. When symptomatic, varicose veins may cause ankle and leg swelling, cramps, and itching. Patients often complain of leg heaviness, tension, and aching.
DIAGNOSIS
BLOOD ANALYSIS
Blood tests are performed to look at general health and to assess risk factors that affect the progression of the disease, including fasting blood cholesterol levels, blood sugar, kidney and liver function, and homocysteine levels.
DOPPLER/DUPLEX ULTRASOUND EXAMINATION
A measurement of blood flow and the identification of sites of vessel blockage is accomplished with the use of a hand-held Doppler probe. This allows the examiner to listen to the blood flow. The most accurate and detailed test, is a Duplex Ultrasound exam. This provides an ultrasound image of the vessel to determine whether there is any blockage or structural damage and is also able to record quality of blood flow as well as localised blood pressure.
TREATMENT
SMOKING CESSATION
Immediate and complete tobacco use cessation is absolutely essential. We require this not only of patients with Varicose Veins, but of all patients with circulatory disorders. Individuals who smoke not only put themselves at risk for developing vascular disease but also undermine attempts at treatment.
Cigarette smoking in particular is known to cause erythrocytosis, plasma volume contraction, and thrombocytosis. These are all conditions which lead to dramatically increased risk of venous and arterial thrombosis.
We understand the difficulty many smokers face in quitting and we work with our patients to overcome this personal challenge. We offer several strategic methods to help them end their addiction and improve their vascular health.
MOST TREATMENTS TODAY
The primary goals of most treatments of circulatory disorders today are to attempt to relieve symptoms and prevent further complications. At present, the majority of treatments act superficially in treating a patient’s symptoms and avoid dealing with the root of the problem.
Standard therapies are often considered for cosmetic purposes and typically include the complete removal of the major veins of the legs. Such therapies not only do not deal with the underlying cause of a patient’s illness, but also deprive the legs of important drainage pipes for the proper return of deoxygenated blood to the heart. As a consequence, over time this increases the pressure within the leg veins leading to the development of Chronic Venous Insufficiency (CVI) and ultimately the formation of non-healing ulcers.
ACHIEVING NEW HEIGHTS IN VASCULAR CARE
At Vascular General, we have developed innovative therapeutic procedures for the treatment of all circulatory disorders of the lower extremities that have consistently produced dramatically successfully results.
Our treatment of Varicose Veins is distinguished in that the decision to undergo surgery is considered as a last resort and only to remove the unnecessary branches, never total removal of the major veins. Our procedures are super-selective and performed under local anesthetic.
In more advanced stages of Varicose Veins, due to the long duration and frequent reoccurrence of open sores or ulcers in the lower extremities, the microorganisms involved in the infection expand exponentially in number and develop into colonies that have a type of protective shield or layer of armor which is resistant to antibiotics. This is why all too often ulcers appear to be non-healing and do not respond to antibiotic medication.
The finding that low dose electric current can disrupt the protective layer shielding microbial colonies is well documented in the scientific literature. Our application of low dose electrotherapy in combination with antibiotic medication has time and again yielded the knockout punch to the life-threatening microbial colonies infecting chronic wounds.
SAVING LIFE AND LIMB
Within a few weeks of our treatments, persistent open wounds that never seem to close and were for so long a constant danger to life and limb, are cleaned from infection, closed, and allowed to heal.
Our innovative use of low dose electrotherapy is not only a vital weapon in the battle against the spread of open wound infection but also a tool for the repair of such damages to the vascular system as inflammation of the vessel wall, ischemia, atherosclerosis, and thrombosis.
COMPRESSION STOCKINGS
The most common treatment of Varicose Veins involves wearing compression stockings (special stockings that apply steady pressure to the leg), to increase circulation. Compression stockings can prevent much of the swelling caused by the disorder.
VASOPNEUMATIC COMPRESSION THERAPY
In addition to standard compression stockings which can only provide static compression, Vasopneumatic Compression Therapy provides intermittent compression. It more closely mimics the muscle contractions that the body uses to force tissue debris and excess fluid out of the affected area and into the lymphatic system for proper drainage. The therapy is designed to compress portions of the leg to enhance blood flow to the extremity. Therapeutic effects from this treatment regimen include the decrease in venous pressure, interstitial fluid pressure, vasoconstriction, and blood viscosity.
SURGERY
For certain individuals surgery may be recommended to bypass the blocked vein or to clean out the area of blockage.
Minimally invasive procedures are performed with an endoscope (a small, flexible tube with a light, optical lens, and probe, forceps, suction device, or other instrument for surgery on the end), they include:
SCLEROTHERAPY: this involves injecting a chemical into the affected veins. The chemical causes scarring in the veins so that they can no longer carry blood. Blood then returns to the heart through other veins and the body absorbs the scarred veins.
STRIPPING LIGATION: surgical removal of a heavily damaged vein
SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY: a procedure in which the perforator veins (veins found in the calf area) are clipped and tied off in order to allow blood to drain into healthy veins
THROMBOLYSIS: catheter-assisted administration of highly concentrated anticoagulant medication to remove or break up a clot
BYPASS SURGERY: If the disease is very advanced, or if it occurs in a vein that is difficult to reach with a catheter, bypass surgery may be necessary. A bypass graft may be performed in such serious cases. This surgical procedure uses either an artificial tube or one of the patients own veins to bring improved blood flow to the affected area.
