BACKGROUND

      MECHANISM

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.

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 specialized one-way valves that open to allow the blood to flow upward, and then shut to keep the blood from flowing back downwards towards the feet.

CVI is believed to occur because these valves are damaged, allowing blood to leak backwards and stagnate in the veins of the lower legs. This in turn increases the blood pressure in the legs and causes inflammation in the veins.

Venous Ulcers are a common outcome of long-term untreated venous insufficiency. 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.

      CAUSE

The cause of CVI is related to poorly functioning vein valves. Vein valves are designed to allow blood to flow against gravity from the legs back to the heart. When the valves fail to close properly, gravity wins and the flow reverses. This is called venous reflux.

Vein valves may fail to close due to any one of the following conditions:  

• Vein wall weakness that causes the vein to enlarge so that the valves cannot close
• A history of blood clots or DVT in the vein that damage the valve
• An absence of vein valves since birth

      PATIENT PROFILE

The incidence of CVI rises with age. Other risk factors of CVI are family history of vascular problems and lifestyle. People with a sedentary lifestyle or who have jobs that involve spending long hours on their feet are at increased risk of developing CVI.

      SYMPTOMS

The most common sign of CVI is ankle and foot swelling that progress up the lower leg. Other skin changes in the lower leg that commonly occur include discoloration, eczema, scarring, hardened and thickening skin, and ulceration.

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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 Venous Ulcers, 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 typically include exercise programmes to try to increase blood supply to the affected tissues and the use of antibiotics to help in treating non-healing ulcers. Treatment of CVI is also directed at reducing and managing leg swelling and improving the flow of lymph fluid.  Such therapies alone do not deal with the underlying cause of a patient’s illness. This is the reason the vast majority of treatments do not succeed.

      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.

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 BANDAGING & STOCKINGS

The most common treatment of CVI involves wearing compression stockings (special stockings that apply steady pressure to the arm and 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.

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SURGERY

In more advanced stages of CVI, 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.