Vein & Vascular Disease
Venous insufficiency is a chronic, often painful disease that results in symptoms that prevent your veins, legs, and body from optimal performance.
Over 80 million Americans experience the effects of vein disease each year, so if you experience symptoms, it is important to take action to prevent further damage to your body. Two of the most common conditions associated with vein disease are varicose veins and spider veins.
Vascular Disease (PAD/PVD)
Vascular disease is a broad heading under which medical diseases of circulation are categorized. Peripheral artery disease (PAD) is typically considered to be the same disease seen in the heart vessels related to smoking, diabetes, hypertension and high cholesterol. It can be seen in the legs, kidney vessels, neck and upper extremities. Peripheral artery disease can lead to significant pain in the legs when walking and is associated with hypertension and stroke. The most severe manifestation of peripheral artery disease in the legs can lead to amputation from a non healing wound.
Peripheral venous disease (PVD) is typically thought of as chronic vein conditions such as varicose veins, leg swelling and the complications of deep vein thrombosis. Peripheral venous disease can lead to leg conditions with leg heaviness and swelling as well as skin discoloration and poor healing of skin. This type of ulceration does not lead to limb loss but can be difficult to treat.
Deep Vein Thrombosis (DVT)
Deep vein thrombosis can be triggered by a number of things. Birth control pills, blood clotting disorders, surgeries or long hospital stays from medical illnesses and cancer. We have seen blood clots from Covid 19 infection and this is a new area for the medical community to tackle. The treatment of blood clots is largely the use of a blood thinner. The duration of medical treatment depends on the situation that caused the clot to form. Bleeding is the most common concern when using blood thinners and can make treatment complicated.
Superficial vein thrombosis is frequently encountered with varicose veins and may or may not be associated with deep vein thrombosis and other medical conditions.
Lower extremity edema has many causes. Patterns of leg swelling are important to understand. Some of the patterns that we look for to help understand root causes of leg swelling include: unilateral vs bilateral swelling, below the knee and above the knee swelling, swelling that is associated with discoloration and varicose veins. This is not a complete list, but when a medical consultation is performed, these patterns will help us establish cause and treatment.
Lymphedema or Lipedema
Lymphedema is a type of edema secondary to insufficient lymphatic drainage of an extremity. It is classically seen in women who have had breast cancer and have had several lymphnodes resected. It can also be seen after repeated bouts of infection in the lower extremity. The typical characteristic pattern in the legs is that it involves one leg worse than another, there is thickened skin in the toes and the top of the foot swells. There does not tend to be discoloration of the skin.
Lipedema is a condition that is frequently confused with lymphedema but the pattern is very different. Lipedema is symmetric. Lipedema does not involve the feet at all. The feet and toes are normal. Patients with lipedema frequently have a body habitus that is bottom heavy and it is common to hear about a familial tendency.
Vascular ulceration can be venous or arterial in origin. They are very different in how they manifest. Venous ulceration is typically seen just above the middle ankle, it is associated with discoloration and may or may not be painful and it typically has a red base. Arterial ulceration is typically painful and on the bony parts of the foot. This type of ulcer usually has a dry hard cap.
Livedoid Vasculopathy and Atrophie Blanche
These two terms are not exactly the same but are frequently used interchangeably. They manifest as small white scars that have a thin base. Typically there is pain associated with these ulcerations while they are open. They can take a very long time to heal and venous insufficiency is a common underlying condition.
Varicose veins are a very common vascular illness and can lead to significant pain and swelling if left untreated. There is a broad spectrum of manifestation of varicose veins from simply being a cosmetic issue to being a cause of venous ulceration.
Treatment of varicose veins is a joint decision. Three categories of treatment are typically discussed, conservative (compression hose), procedural or minimally invasive procedures (ablations and injection therapy) and surgical.
Other Vascular Conditions
- Carotid artery disease
- Thoracic outlet syndrome
- Renal artery stenosis
- Mesenteric artery disease (MAD)
- Raynaud's disease
- Klippel Trenaunay Syndrome
- Ehlers Danlos Syndrome (Type 4)
- Fibromuscular Dysplasia