Lakeview Health System
Vein Disease

-Eric Saterbak, MD

Many patients come to our clinic complaining of chronic leg pain, swelling, heaviness and fatigue. Often, the cause of these symptoms is a vein disease known as chronic venous insufficiency. 

Vein disease of the legs remains a major burden on patients and health care facilities throughout the western world. Fortunately, the understanding of this disease (and the treatment available for it) has never been better. Often, the mention of vein disease makes many people think of unsightly varicose veins and spider veins. While varicose veins are often the most visible sign of vein disease, the condition is often much more than cosmetic and can, over time, lead to serious and difficult to manage complications.

There are three types of veins in the legs, classified by their anatomic location. Superficial veins are the kind that can easily be seen through the skin and are the veins that become enlarged in patients with chronic vein disease. Deep veins are deep in the muscles of the leg and drain blood directly into the large veins of the abdomen and pelvis. Communicating veins connect the superficial and deep veins. Blood returns to the heart through these veins and flow is regulated by thin sheets of tissue, called valves.

Varicose veins develop when the valves no longer function and blood flows backwards from deep veins and into the superficial veins. This increases the pressure in those veins and causes them to become enlarged. This increased pressure not only results in visually apparent varicose veins, but can also lead to pain, swelling and fatigue. In severe cases, the skin around the lower legs and ankles becomes discolored, thickened and can even develop ulcers, or chronic open wounds that become very difficult to heal. While we don’t always know what causes the valves to fail, we do know heredity, multiple pregnancies and obesity are all contributors. 

It is estimated that varicose veins exist in 15-20% of the adult population in the United States. Six percent of those people have vein disease that has progressed to the point of open wounds.  The yearly cost to our health systems of managing vein-related ulcers is estimated to exceed $1 billion. Because of the debilitating symptoms of early disease and the potential complications of late disease, we strongly recommend that people with symptomatic vein disease of the leg be evaluated and treated.

If you feel as though you may have symptoms of vein disease, the first step is to see your practitioner or a surgeon who performs vein procedures. He or she will likely evaluate your veins with an ultrasound, which shows the size of the veins and whether or not the valves are working. Treatment for venous disease typically starts with form fitting, individualized compression stockings for the legs. This, along with meticulous attention to elevating the legs when not standing, is enough to alleviate symptoms in some patients. 

If these simple measures fail, however, surgical intervention is often pursued. Open vein stripping is a technique in which a catheter is fed down the largest of the superficial veins (the greater saphenous vein) and then removed in order to physically pull the vein from the leg. This technique is still used today but has largely been replaced by endovenous ablation, in which a catheter with a heating element is introduced into the vein in order to destroy it from the inside – ultimately turning the vein into a cord of scar tissue. Success rates with this technology and resolution of symptoms are exceptionally high.

Not all leg swelling and pain are caused by vein disease, but a simple ultrasound may tell you if you’re a candidate for vein treatment. If you have these symptoms, consider seeing your provider for evaluation.