Scripps Health offers the latest medical and surgical treatment options for people who have varicose veins or other chronic vein insufficiency.
Medical conditions that affect the veins are often collectively referred to as venous disease or venous disorders, and range from common conditions such as varicose veins, to rare disorders that can be difficult to diagnose, including pelvic congestion syndrome and May-Thurner syndrome.
Because vein disease often causes visible symptoms such as protruding veins, swollen legs and discolored skin, it’s easy to assume they are simply cosmetic issues. However, if left untreated, venous disorders can pose serious health risks including blood clots that block blood flow to the lungs.
Scripps doctors have experience managing even the most complex vein conditions, and are proud to offer the latest minimally invasive procedures that collapse and seal problem veins or break up and remove dangerous blood clots.
Scripps physicians diagnose and treat a variety of medical problems that affect your veins and impact blood flow.
Your circulatory system relies on a vast network of vessels called arteries and veins to transport blood throughout the body.
Every time your heart beats it pumps blood, which is full of life-sustaining oxygen. Your arteries carry this blood away from your heart to all of your organs, then your veins complete the circuit by bringing the blood (at this point depleted of oxygen) back to your heart.
Your veins contain tiny flaps, called valves, which have the ability to open and close. An open valve allows blood to flow freely through your vein, while a closed valve ensures blood can only flow in one direction (toward your heart).
If the valves inside of your veins become diseased or damaged, they may not close completely. This means blood won’t flow properly – it will either leak backward, or flow in both directions. Over time, improper blood flow can lead to a variety of problems including blood clots, swollen veins, leg pain, skin discoloration and open sores.
While vein disease can occur anywhere in the body, it often affects the legs due to a combination of anatomy and nature; in order to travel back up to your heart from your feet and legs, your blood and venous valves must fight against gravity. If you have problem veins in your legs, it’s easier for your blood to pool, which causes increased pressure inside the veins and eventual valve damage.
Scripps physicians treat the full range of venous disorders, ranging from unsightly varicose veins to life-threatening blood clots, using a combination of medical and surgical treatments. Our vascular surgeons have extensive experience managing the following conditions:
- Varicose veins, or swollen, discolored and knotty-looking veins in the legs that are easily seen through the skin.
- Venous ulcers, also known as stasis ulcers, are shallow but slow-healing wounds that form on the skin, usually on either side of the leg between the calf and ankle.
- Chronic venous insuffiency occurs when the valves in your leg veins don’t close properly, allowing blood to collect or “pool” in the veins. This causes leg swelling and achiness, and puts you at a greater risk of developing varicose veins and venous ulcers.
- Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in one of the so-called “deep veins” that are found inside your muscles. Although a deep vein clot can form anywhere in your body, including your arms and chest, it frequently occurs in the legs. DVT can become life-threatening if the clot travels through your body, becomes stuck in a blood vessel, and blocks blood flow to your lungs (a condition known as pulmonary embolism).
- Iliofemoral DVT is a type of deep vein thrombosis that occurs specifically in the iliac and femoral veins, which run from the lower leg up into the lower abdomen. Patients with iliofemoral DVT are often at greater risk for long-term medical problems than those who have DVT in another part of their body, and often require more aggressive treatment.
- May-Thurner syndrome (MTS), also known as iliac vein compression syndrome, occurs when the right iliac artery presses the left iliac vein against the lower spine. Because the vein is compressed, blood cannot adequately flow through it and often pools in the left leg. Someone with a compressed iliac vein is at much greater risk of developing DVT than the average population.
- Pelvic congestion syndrome, (also known as pelvic venous incompetence) a painful condition that causes varicose veins to form near a woman’s ovaries or uterus.
- Arteriovenous malformations (AVMs) occur when an abnormal connection between veins and arteries that’s present at birth causes them to tangle, disrupting proper blood circulation. While AVMs can form anywhere in the body, they pose the most risk if located in critical structures such as the brain or spinal cord.
Most forms of vein disease cause the following symptoms, often present in the lower legs:
- Bulging, twisted veins that are easily visible through the skin
- Swollen legs and ankles
- Pain, aching, or a heavy feeling in the legs
- Skin discoloration and itching in the legs
- Open sores on the lower legs, often between the calf and ankle
- Women with pelvic congestion syndrome may experience chronic pain in their pelvic region
Because venous disorders such as deep vein thrombosis (DVT) can be life-threatening, people with the following symptoms should call their doctor or 911 immediately:
- Sudden swelling, pain or cramping in one leg
- Sudden shortness of breath
- Chest pain that gets worse when you take a deep breath
- Rapid pulse
- Coughing up blood
- Sudden dizziness, light-headedness or fainting
Risk factors for venous disease include:
- Age (50 or older)
- Family history of vascular disease
- Tobacco use
- High blood pressure
- High cholesterol
- Among women, pregnancy and use of medications such as birth control or hormone replacement therapy can increase risk of varicose veins and DVT
Scripps doctors can accurately diagnose vein problems using one or more of the following tests:
- Vascular ultrasound, also called a duplex ultrasound, is a non-invasive imaging procedure that allows doctors to evaluate how blood is flowing through a vein or artery. In addition to detecting narrowed arteries, vascular ultrasound can also identify blood clots that have formed in veins.
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Conventional angiography
Scripps offers the full range of medical and surgical treatments for venous disorders, including the latest minimally invasive, laser- and catheter-based procedures. Venous treatments typically work in one of two ways, either by collapsing and permanently closing a problem vein, or by breaking up or removing a blood clot before it can cause further harm.
The six procedures listed below are typically used to address vein problems that do not involve blood clots, including varicose veins, venous ulcers and chronic venous insufficiency.
- Endovenous thermal ablation, also known as catheter-assisted heat ablation, uses heat delivered by a catheter to destroy a problematic vein.
- As the name implies, endovenous laser therapy (sometimes called laser surgery) uses laser technology to collapse a vein and seal it shut.
- Injection-compression sclerotherapy uses a chemical solution, injected directly into the vein, to help the vein walls stick together and seal shut.
- Ultrasound-guided sclerotherapy is an advanced form of injection-compression sclerotherapy. During the procedure, ultrasound technology helps detect problem veins that are not visible on the skin’s surface. Once these veins are located, they can be injected with a chemical solution that permanently closes them.
- Ambulatory phlebectomy is a minimally-invasive surgical procedure that allows physicians to remove varicose veins that are close to the surface of the skin. The veins are removed from the leg through tiny incisions made in the skin. The incisions are small enough to heal on their own (no stitches required).
- Coil embolization, also known as endovascular coiling or endovascular embolization, is a minimally-invasive procedure that allows surgeons to close off a faulty vein. During the procedure, a catheter is used to place a tiny metal coil into the vein, which prevents blood from flowing into it. Coil embolization is often used to treat chronic venous insufficiency and pelvic congestion syndrome.
The final three procedures described below are used to treat conditions such as DVT, which require destroying or removing a blood clot. These procedures may be used alone or in combination with one another:
- Thrombolysis, also known as thrombolytic therapy, is used to dissolve a blood clot with medication injected directly into the vein.
- Thrombectomy is a minimally-invasive surgical procedure that uses catheters to either break up or remove a blood clot from a vein.
- Venous angioplasty and stenting is an endovascular procedure used to treat a vein that has been narrowed or blocked. During the procedure, a balloon-tipped catheter is used to both inflate the vein and to insert a tiny tube called a stent that will keep the vein propped open.