HEALTH & BEAUTY :: AUGUST/SEPTEMBER 2008
Venous Insufficiency & Varicose Veins
Venous insufficiency, a.k.a., venous reflux, is the impaired return of venous blood from the legs and feet, often manifesting as varicose veins, swollen ankles, aching legs, skin changes or venous ulcers.
In many cases, venous insufficiency is the result of over-dilation of the venous vessels in the legs. This dilation eventually prevents the valve cusps from closing properly resulting in reflux. The pooling of blood results in ineffective flow back to the heart.
In some cases the reflux is caused not only by the over dilation of the vessel wall, but also by damaged or absent valves.
One of the most common clinical manifestations of venous insufficiency is varicose veins. Varicose veins are superficial veins that have dilated in response to increased pressure due to incompetent valves. These varicose veins progressively worsen, and often manifest into other symptoms, if left untreated.
Approximately 24 million Americans have varicose veins. Approximately 6 million Americans have skin changes associated with Chronic Venous Insufficiency (CVI). Venous stasis ulcers affect approximately 500,000 people.
Nearly 70% of all women and 30% of men will develop some type of venous disorder due to insufficient blood circulation. Although the exact cause is unknown, there are many that contribute to the weakening of the vein walls including:
- Heredity
- Pregnancy
- Hormonal factors
- Being overweight
- Standing or sitting for long periods of time
- Advancing age
- Injury
Heredity is the number one contributing factor causing varicose and spider veins. Women are more likely to suffer from abnormal leg veins. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury.
The mean incidence for hospital admission for CVI is 92 per 100,000 admissions.
Varicose veins are typically found in the superficial venous system and often involve the main trunk veins - the great and small saphenous veins - as well as tributaries.
Varicose veins are superficial veins that have expanded in response to increased pressure caused by incompetent or absent valves. This dilation eventually prevents the valve cusps from closing properly resulting in reflux. Alternatively, a lack of competent valves can also cause dilation of the vein. As one valve fails, increasing pressure is exerted on each more distal valve until they, too, become incompetent. Diameters of varicose veins can range from 3 mm to > 8 mm.2
Varicose Veins alone have been estimated to occur in 15-20% of the population depending on gender. Aging of the population and increase in the rate of obesity may only increase this prevalence. Chronic venous insufficiency syndromes are a major cause of lost time from work and decrease productivity, and engender significant amounts of direct and indirect health costs (1).
A large amount of information can be gleaned quickly with a fairly simple ultrasound survey of the legs as can be performed in the office. Working diagnoses can be confirmed with studies done in accredited vascular labs. The most common problem of varicose veins and chronic venous insufficiency can be diagnosed reliably and treatment performed with ultrasound-guided ablation of refluxing and dilated greater or lesser saphenous vein trunks. Ablations can be performed in an office setting with a variety of radiofrequency or laser techniques. The procedure is performed completely with local anesthesia and has no significant recovery time, as patients are encouraged to walk immediately afterward. We have found that the worst pathologies have the most dramatic improvements.
For more information or to schedule a consultation, contact Surgical Associates, P.A. in Dover at (302)674-0600 or in Milford (302)424-0300. www.vnus.com
Testimonials:
"I was surprised at how quick it took, and really pain free and that's not an exaggeration it was pain free." ~Kate S., Dover, DE
"I had torturous veins. Now they're really flat… The appearance is much better." ~Joan L., Viola, DE
"I tell anyone who has these not to put off treatment. Literally, the next day, it was like a miracle." ~Jim W., Smyrna, DE
“I was shocked at how quickly I recovered. I was on the phone with my office as soon as I got home from the hospital. I’ve had more discomfort after a dental appointment than I had after this procedure.” ~John D., Elkton, MD
Thomas P. Barnett, M.D., F.A.C.S.
Raised in Oyster Bay, N.Y., Dr. Barnett graduated from Princeton University in 1983 and obtained his medical degree from George Washington University in 1987. He completed his surgical training at the Lankenau Hospital in Philadelphia, PA from 1987-1992 and served in the U.S. Air Force at Dover AFB from 1992-1996. Dr. Barnett was Chief of Surgery at Dover AFB Hospital in 1995 & 1996. He has continued to practice surgery in Dover, DE ever since being honorably discharged. Dr. Barnett is Board Certified and is a Fellow of the American College of Surgeons. In addition, he is the President of the Eden Hill Medical Center and the Delaware Surgery Center. Dr. Barnett has been voted as “Top Doctor” in the field of General Surgery in the Delaware Today Magazine.
