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Veins & Arteries

  • Varicose Veins

    What are varicose veins?
    One-way valve failure in the major superficial leg veins is the most common cause of vein reflux and causes varicose veins in other parts of the leg. Venous reflux stretches the vein and puts additional pressure on the other healthy valves. This results in varicose veins that appear as tortuous, enlarged blue veins that bulge from the surface of the skin. Varicose veins in the legs are common and affect 3 in 10 people in the general population, typically between the ages of 30 and 70. They prevent blood clearing effectively from your legs, and causes symptoms of veins.

    Symptoms of varicose veins:
    Varicose veins symptoms are varied and some patients have no symptoms. Common symptoms of varicose veins include leg pain, swollen ankles and feet, itching, heavy legs, tired and aching legs. More severe symptoms include skin changes like darkening around your ankles, chronic inflammation, dry, scaling skin, leg swelling and calf pain.

    Causes of varicose veins:
    The exact cause of varicose veins is not yet known. There are however a number of risk factors: Family history, standing or sitting for long periods, pregnancy, obesity, injuries and old age.

    Complications of varicose veins:
    Common complications of varicose veins include: Venous ulcers, venous eczema, itching skin, chronic leg pain, superficial blood clots, leg cramps, restless legs, swelling of legs, skin pigmentation, bleeding veins, tired and heavy legs.

    Diagnosis of varicose veins:
    Venous duplex ultrasound scanning is the current gold standard in the diagnosis of vein disease. It involves the use of an ultrasound machine and high frequency probe to accurately asses the anatomy of your veins as well as the flow patterns within them.

    Treatment of varicose veins:
    Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance. Implementing lifestyle changes only, will not remove varicose veins. Lifestyle changes include: avoid prolonged standing or sitting, loose weight, leg exercises, compression stockings and leg elevation. Modern medical treatment of varicose veins include: radio frequency ablation, endovenous laser ablation and ultrasound guided foam sclerotherapy.

    Prevention of varicose veins:
    Current understanding of varicose veins suggest that you cannot prevent varicose veins from forming but can prevent the ones you have from getting worse. You also can take steps to delay other varicose veins from forming. These measures are the same as listed above in lifestyle changes.

  • Deep Vein Thrombosis

    Deep Vein Thrombosis (DVT)
    Deep vein thrombosis is a clot within the main / deep veins of the leg and if left untreated can extend in to other veins. DVT’s can occur spontaneously or after triggering events, such as trauma, surgery or illness. The most commonly affected veins are the popliteal and femoral veins in the leg. Prevention is the single most important measure in the management of deep vein thrombosis. Complications of DVT include potentially life-threatening pulmonary embolism – where part of the clot breaks-off and pass to the heart and lungs and post-thrombotic syndrome with leg pain and ulcers.

    Symptoms of DVT:
    DVT’s can present with calf or thigh tenderness, swelling of the limb, warmth to the skin, redness, distention of surface veins. Up to 50% of patients with DVT’s do not have any symptoms.

    Causes of DVT:
    It is important to find out the cause for a DVT. In many cases there is an obvious cause – such as recent surgery, dehydration or a long haul flight whilst on the oral contraceptive pill. Many patients with DVT however have no known cause for their DVT. Such patients need to be investigated for other illnesses such as an undiagnosed cancer. Risk factors for the development of DVT include – advanced age, Major surgery, cancer, inactivity or immobility, pregnancy, trauma or leg injury, Oral contraception and HRT, obesity, HIV and infection.

    Venous duplex ultrasound scanning is the current gold standard in the diagnosis of DVT. It involves the use of an ultrasound machine and high frequency probe to accurately assess the anatomy of your veins as well as the flow patterns within them.

    Treatment of DVT:
    Prompt diagnosis and treatment of deep vein thrombosis (DVT) is essential to decrease both the risk of recurrence and further complications. Treatment consists of thinning your blood by taking medications such as anti-coagulants. The use of compression stockings is an important adjunct to pharmacological treatment. Other venous thromboembolism (VTE) treatment approaches may include: surgery; catheter-guided thrombectomy; or thrombolytic therapy.

    Complications of DVT:
    • Pulmonary embolism: blood clot traveling up to the lungs.
    • Post-thrombotic syndrome (PTS): chronic venous ulcers and leg pains. PTS is a condition that is associated with a substantial loss in quality of life .

    Prevention of DVT:
    Walking and calf exercises is an important measure to prevent DVT. Some patients might require long term anti-coagulation to prevent recurrence of DVT. If you have multiple family members with past DVT or PE, you should be medically investigated for a clotting disorder.

  • Chronic Venous Ulcers

    Leg Venous Ulcers
    Venous leg ulcers are a consequence of venous hypertension that develops because of an inadequate calf muscle pump action and venous valve failure. Failure of these systems causes high blood pressure within the veins of the legs resulting in venous ulcers. Venous valves may fail without an underlying reason or secondary to previous pathology such as deep vein thrombosis (DVT).

    What are venous leg ulvers?
    An ulcer is a break in the skin or an open wound. Venous ulcers vary in size and might be a small wound around your ankle or a very large wound involving most of the lower leg. They occur in the gaiter area of the leg, which is around the inside area at the ankle. The skin surrounding the ulcer is often affected by pigmentation. Although venous leg ulcers are the most common type of lower leg ulcer, it should always be distinguished from other causes of leg ulcers including arterial, neurotrophic and diabetic ulcers.

    Venous leg ulcer symptoms:
    Venous leg ulcers often presents with open, non-healing wounds with fluid oozing and pain that is relieved on leg elevation. Some venous ulcers are asymptomatic. Venous ulcers can become infected from time to time, which often leads to increased symptoms of pain, oozing and an odour to the wound.

    Causes of venous leg ulcer:
    Venous leg ulcers are the most common type of leg ulcer(80%), followed by arterial ulcers(15%).It is still not fully understood why venous ulcers form. In the recent past it was thought to be due to venous reflux within the deep / main veins of the leg.

    Treatment of venous leg ulcers have been revolutionized over the past few years. Advanced endovenous techniques yields excellent results in ulcer healing. Every venous ulcer patient is unique and as such requires a specialist approach in investigation and treatment of the ulcer. The average scenario would be a patient with an ulcer, with superficial vein reflux, treated by endovenous radio frequency ablation and specialized wound dressings until healed.

    Prevention of venous ulcers:
    Venous ulcers can be prevented by having venous reflux treated. The current treatment of choice in patients with superficial vein reflux is endovenous ablation by radio frequency catheter.

    Diagnosis of venous ulcers:
    Venous duplex ultrasound scanning is the current gold standard in the diagnosis of vein disease. It involves the use of an ultrasound machine and high frequency probe to accurately asses the anatomy of your veins as well as the flow patterns within them.

  • Superficial Thrombophlebitis

    What is superficial thrombophlebitis?
    Superficial thrombophlebtis ( inflammation of veins) can happen in any of the superficial veins in the body.Thrombophlebitis is a benign and self limiting condition in most instances. Where the greater saphenous vein is involved, the clotting might extend into the deep vein, which would pose a more serious risk.

    Examination of the area would reveal tender superficial veins, redness, warm and slight swelling. Further investigation with duplex ultrasound might be undertaken to access the extent of the thrombosis or clotting.

    Superficial thrombophlebitis can occur spontaneously, especially in the greater saphenous vein in the legs. Although the etiology is frequently obscure, superficial venous thrombosis is most often associated with one of the following : vein injury(which can result from trauma, infection, or inflammation), stagnant or turbulent blood flow (often found in varicose veins), or changes in blood constituents (dehydration for instance lowers the water content of blood, making it more prone to clotting).

    Complications are an uncommon feature of superficial thrombophlebitis. However the following can happen – extension of the clot into the deep vein, with resultant deep vein thrombosis and possible pulmonary embolism. Conversion into a infected form of phlebitis known as septic thrombophlebitis. After the acute episode hyperpigmentation of the skin can persist. Also a persistent firm nodule under the skin.

    The treatment of superficial thrombophlebitis depends on the cause, extent, and symptoms. For the superficial, localized, mildly tender area of thrombophlebitis treatment with mild analgesics, such as aspirin or ibuprofen, and the use of some type of support bandage or stocking is usually sufficient. Patients are encouraged to continue their normal daily activities. If extensive varicose veins are present or if symptoms persist despite treatment, then a minor procedure such as a phlebectomy of the involved vein may be indicated. More severe thrombophlebitis should be treated with elevation of the leg and
    application of large, hot, wet compresses.

    Thrombophlebitis is a known complication of varicose veins. Treatment of varicose veins would minimize risk of suffering thrombophlebitis.