Healthy veins are crucial to our overall well-being, so it's about time a medical specialty was developed and dedicated to monitor the ailments and conditions related to veins. Phlebology is defined as the treatment of veins. Over the last eight years, the treatment of the venous system has evolved into its own specialty and has its own certifying board which is called The American Board of Phlebology.
Until somewhat recently, the only treatment for varicose veins was a procedure called stripping of the veins, which involved multiple incisions and multiple stitches and, in effect, resulted in the trading of a vein for a scar. Also, the treatment for spider veins was only by injecting a saline solution called sclerotherapy. This saline solution had many side effects including brownish discoloration, pain with injections, phlebitis and even ulcerations of the skin. Over this last eight-year period, the state-of-the-art treatment of veins now is vein closure either with a laser or a radiofrequency filament and sclerotherapy of the veins usually with a foam solution or with a glycerin solution.
The usual vein symptoms consist of:
- Aching
- Cramping
- Burning and swelling of the legs
- The physical findings of varicose and spider veins
Usually associated with vein symptoms is a strong family history of vein problems and, in women, prior pregnancies frequently lead to either varicose or spider veins. The underlying mechanism involved with both spider and varicose veins is something called valvular insuffiency. What this means is that the valves in the veins which carry the blood from the feet up towards the heart fail to close properly. In so doing, the blood does not go through the valves as it should and goes around the malfunctioning valves through the skin in the form of the spider and varicose veins. This could only be adequately diagnosed by a noninvasive ultrasound test.
Unusual vein symptoms include the following:
1. Brownish discoloration of the legs
Brownish discoloration of the legs is something that occurs chronically over time. It is usually related to an underlying vein valve closure problem. We technically call this reflux. Reflux means that instead of going from the feet up towards the heart, blood goes in the reverse direction back towards the feet. Since the blood flow is going in a reversal of flow, this ultimately leads to something called venous hypertension (high blood pressure in the veins) which leads to the venous blood leaking out of the veins and causing discoloration of the skin. This discoloration becomes brown in color and leads to a thickened weakened skin. This skin is prone to ulceration, infection, cellulitis, itching and even a chronic condition called lymphedema.
2. Leg swelling
Varicose veins in general will not cause vein swelling. However, advanced cases of varicose veins and advanced cases of chronic insufficiency of the valves will lead to chronic swelling of the legs. Often times, patients present with a heaviness and increase in size of the legs especially around the calf and ankles. Again, the diagnosis is usually made based on an ultrasound which shows valvular insufficiency.
3. Restless leg syndrome
It is noteworthy, that if you notice multiple ads on TV for medications to prevent restless leg syndromes, none of these ads recommend obtaining a venous ultrasound or vein therapy as the treatment for restless leg syndrome. Instead they recommend expensive medications which are fraught with multiple complications. Restless leg syndromes are often due to valvular insufficiency and result in chronic venous stasis which leads to the back up of venous blood and venous hypertension.
4. Ulceration around the ankle area
This could be either on the inside or outside of the ankle, but most commonly on the inside. This ulceration is due to weakening of the skin from the backup of the venous blood and the long standing venous hypertension. Ultimately, the skin weakens, breaks down and ulcerates. It is very difficult to heal these ulcerations and they are prone to become infected.
The unusual symptoms of venous insufficiency are not commonly recognized by the average non medical person. All of these can be diagnosed by a venous ultrasound, which should be performed by a Registered Vascular Technician, who is specifically trained to do the test and look for these unusual abnormalities. The test should also be interpreted by a person certified to interpret the ultrasonic examination. These credentials should be looked for when you are having your ultrasound interpreted.
