As published in 4Health Magazine
Superficial Venous Insufficiency: Diagnosis
Heaviness, tiredness, easy fatigue of lower extremities, difficulties walking, standing or even sitting - thorough examination of venous insufficiency disease.
Many conditions unrelated to venous circulation can mimic vein diseases. Moreover, established presence the vein disease does not exclude co-existence of the other problems. It takes, therefore, some time and patience to perform an appropriate evaluation and to come up with a correct diagnosis prior to starting any kind of treatment.
Typically, the early symptoms of superficial venous insufficiency are vague. Furthermore, due to their gradual and prolonged development taking sometimes years, people with this disease become used to the symptoms often interpreting them as a sign of becoming older or writing them off to diabetes or smoking. The initial symptoms of the disease are variable. The most often complaint, however, is related to difficulties walking and is called “venous claudication”. Often, it is being described as heaviness, tiredness, easy fatigue of lower extremities, difficulties walking, standing or even sitting still. Depending of the level veins involved, location of the pain or rather, dull ache or deep discomfort, how the majority of the patients describe it, could be anywhere in the lower extremities. More often, it can be localized to the ankles.
Despite to the fact, that the most common predisposing factor for superficial venous insufficiency is hereditary, there are well-recognized external contributing factors, significantly affecting the development and the course of the disease. Some of them are prolonged standing or motionless sitting, 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 differentiate the above categories, it is common to refer to the diseases with strong hereditary factor as to “primary” superficial venous insufficiency. While the ones where external influence was independent pathological factor, are often being called as “secondary” to such condition superficial venous insufficiency.
Based on the above, mentioned causative or associated with them factors are being mentioned by the patients as such affecting either beginning of the disease or its progression. Coincidentally, varicosities or spider veins might or might not be seen depending on multiple factors, 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.
As venous disease progresses, other symptoms join. Of importance is the fact, that 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 with all their consequences. 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, people feel very uncomfortable keeping their 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, are the most typical sign of superficial venous insufficiency, similar in their physiology to the above restless leg syndrome.
Despite the fact, that diagnosis of superficial venous insufficiency is a clinical one, being made based on the complaints and physical examination, venous duplex ultrasound is an important diagnostic modality. This study allows not only to confirm the clinical diagnosis, but also to identify important anatomical and physiological details of the disease, which play often an important role in further therapeutic management. Moreover, often the above study with some modifications 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 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.
Lev M. Khitin, M.D., F.A.C.S.