Diagnosing superficial venous insufficiency is not always easy. Many conditions unrelated to venous circulation can mimic vein diseases. Also, the established presence of vein disease does not rule out the potential for other coexisting conditions. Therefore, it takes some time and patience for your doctor to perform an appropriate evaluation and to come up with a correct diagnosis prior to starting any kind of treatment.
The early symptoms of superficial venous insufficiency tend to be pretty vague. Due to their gradual and prolonged development, which can sometimes take years, people with this disease become used to the symptoms. They often interpret them as a sign of growing older or writing them off to diabetes or as the result of smoking. The initial symptoms of the disease are variable. The most common complaint is related to difficulties walking and is called venous claudication. The overall feeling is often described as heaviness, tiredness, easy fatigue of lower extremities, and difficulties standing, walking or even sitting still. Depending on the kind of veins involved, the location of the dull ache or deep discomfort, the condition could be anywhere in the lower extremities. Frequently, it can be localized to the ankles.
Despite the fact that superficial venous insufficiency is most commonly a hereditary condition, there are recognized external contributing factors as well, significantly affecting the development and the course of the disease. Some of them are prolonged standing or motionless sitting, having multiple pregnancies, habitual heavy lifting, obesity, some disorders of connective tissue, pelvic tumors or traumas, surgical operations in the lower abdomen or pelvis and many others.
There is also a different group of causative factors — the ones much less dependent on genetic predisposition. Those include congestive heart failure, renal failure, fluid overload during intravenous chemotherapy, radiation therapy of the lower extremities or pelvis and such. To understand the differences between the two categories, it is common to refer to the diseases with strong hereditary factors as “primary” to superficial venous insufficiency. While the ones where external influence was independent of pathological factors are often being called as “secondary” to such conditions as superficial venous insufficiency.
Coincidentally, varicosities or spider veins may or may not be seen depending on multiple variables, including thickness of the skin and its color, amount of fat tissue under the skin and so on. The same applied to the other visible changes, such as pigmentation and others.
Symptoms during progression
As venous disease progresses, other symptoms join. Due to very slow and prolonged development of superficial venous insufficiency, its specific pathway of development is a subject of the greatest variability, being affected by details of individual anatomy or types of daily activities. Some patients suffer from progressive disabling pain with no visible symptoms of the disease for years prior to the correct diagnosis made. While others, after a short period of swelling, develop infections and trophic lesions. Yet, some other patients with no subjective symptoms or complaints, suddenly start bleeding from a large varicose vein not visible by naked eye.
Dreaded thrombophlebitis is yet another way superficial venous insufficiency might indicate its presence. Yet another presentation of the disease is so-called restless leg syndrome. During this condition, you would feel very uncomfortable keeping your legs still. The most discomfort takes place early at night, often immediately after going to bed. Leg cramping, particularly at night or during other prolonged either horizontal or reclined position, is the most typical sign of superficial venous insufficiency, similar in their physiology to restless leg syndrome.
Despite the fact that diagnosis of superficial venous insufficiency is a clinical one, based on the complaints and physical examination, venous duplex ultrasound is an important diagnostic modality. This study allows your doctor to not only confirm the clinical diagnosis, but also to identify important anatomical and physiological details of the disease, which often play an important role in further therapeutic management. Sometimes this is the only modality required not only to establish and confirm the diagnosis, but also to start and continue the treatment.
Venous insufficiency is a serious disease and proper early diagnosis can alleviate a lot of pain and suffering. Our clinics have helped thousands of New Yorkers to ease or eliminate the various symptoms of venous insufficiency. To schedule an appointment, please call (212) 575-VEIN (8346). Our offices are located in Brooklyn and Manhattan.
By Lev M. Khitin, M.D., F.A.C.S.
As published in 4Health Magazine