Stasis ulcers are open wounds on the medial or lateral portion of the calf or foot that are at risk of infection. They may take a long time to heal and they may need the assistance of a podiatrist or wound clinic to help them heal. An ulcer is caused by the stasis or pooling of blood in the ankles or feet. This pooling blood causes a breakdown of the skin. Over time the skin becomes very fragile and a small scrape can cause an ulcer to develop. Treating varicose veins can aid in the healing process of active ulcerations.
A perforator vein is a small vein that connects the deep and superficial systems together. They are usually short in length and have only a few valves in them. They can have reflux just like other veins in the legs. These small connector veins run horizontally across the leg and not vertically up and down the leg. It is like the horizontal cross on the letter H. These perforators can be the source to visible varicose veins in the calf or thigh.
Every patient at IVC is unique. Therefore, everyone is not going to be the same. Most patients will have a treatment plan that will take anywhere from 6 to 8 weeks up to 14 to 16 weeks depending on how many veins need treatment. The initial plan may change after the first couple of treatments and could be shortened or lengthened compared to the initial plan. Follow-up appointments are how we determine what needs to be done next and if we need to change the treatment plan. Varicose vein treatment is not something that can be treated all at one time so expect anywhere from 8 up to 16 weeks for completion of your treatment plan.
It is very important to utilize ultrasound after each procedure to check the areas that have been treated for two things. First, we are checking the area of treatment for successful vein closure. Second, we are looking for any problems or complications from the procedure, such as blood clot in the deep or superficial system. This follow up ultrasound also gives us an idea of the remaining problems that need to be treated and allow us to adjust your treatment plan accordingly.
Varicoceles are a relatively common condition (affecting approximately 10 percent of men) that tend to occur in young men, usually during the second or third decade of life. Sometimes these varicoceles cause no symptoms and are harmless, but sometimes a varicocele can cause pain, atrophy (shrinkage), or fertility problems.
Normally blood flows to the testicles through an artery and flows out via a network of tiny veins that drain into a larger vein that travels up through the abdomen. Varicoceles occur when there is a reverse of blood flow. This stretches and enlarges the tiny veins around the testicle to cause a varicocele, a tangled network of blood vessels also known as varicose veins.
One of the signs of a varicocele is an aching pain when the individual has been standing or sitting for an extended time and pressure builds up in the affected veins. Usually (but not always) painful varicoceles are prominent in size. Atrophy, or shrinking, of the testicles is another sign of varicoceles. The condition is often diagnosed in adolescent boys during a sports physical exam. When the affected testicle is smaller than the other, repair of the varicocele is often recommended. The repaired testicle will return to normal size in many cases.
There is an association between varicoceles and infertility or sub-fertility, but it is difficult to be certain if a varicocele is the cause of fertility problems in any one case. Other signs of varicoceles can be a decreased sperm count, decreased motility, or movement of sperm, and an increase in the number of deformed sperm. It is not known for certain how varicoceles contribute to these problems, but a common theory is that the condition raises the temperature of the testicles and affects sperm production.
Typical varicocele symptoms are mild and many do not require treatment. Treatment may be necessary if the varicocele is causing discomfort or any of the other problems listed above.
The diagnosis of Pelvic Congestion Syndrome is best confirmed using pelvic venography performed in the hospital. A pelvic ultrasound or other imaging study is performed prior to the venogram to rule out any anatomical abnormalities. A venogram is performed on an outpatient basis, and takes about two and a half hours from the time the procedure is started to the time you will leave the hospital. The procedure consists of inserting a thin plastic, flexible catheter about the size of a strand of spaghetti into the jugular vein in the neck. Dye is then injected into the veins of the pelvis and x-rays are taken. With the injection of dye, the interventionalist can visualize the abnormal reflux in pelvic varicosities. PCS is treated by placing tiny coils into the faulty veins to seal them off and relieve the aching pressure. The catheter is then removed and a small dressing is applied. After treatment, patients can often return to normal activity immediately.
Embolization is much less invasive than surgery. It also offers a proven, safe and minimally invasive treatment option to the traditional surgery such as hysterectomy. Although pelvic venogram is a viable treatment, other options do exist for treatment of pelvic congestion syndrome. Birth control pills or hormones may be used to stop menstrual cycles which may be beneficial in decreasing symptoms. Analgesics may be used to decrease pain. Surgical treatment is also available which includes a hysterectomy and tying off or removing the varicose veins.
Pelvic venogram offers a less expensive and less invasive effective treatment for pelvic congestion syndrome when compared to surgical treatment. Approximately 75 percent of women experience an improvement in their symptoms after the procedure. Although women’s symptoms usually improve, additional treatments may be necessary because veins in the groin or legs are still dilated and bulging.
There are many different causes of pelvic pain, but sometimes it is related to the existence of ovarian and pelvic varicose veins. Varicose veins are a result of valves in the veins that don’t work correctly. Valves are designed to help veins return blood to the heart by preventing back-flow of blood down the vein. When the valves don’t work, this lets the blood pool resulting in vein bulging and pressure.
Studies show that up to 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a primary cause of their pelvic pain. The majority of women with PCS are less than 45 and are in their childbearing years. Risk factors for PCS include multiple pregnancies, polycystic ovarian syndrome, hormonal dysfunction and leg varicose veins. Women with PCS usually complain of a dull ache and heaviness in the pelvis that is worsened by standing, pregnancy, and menstruation. Sometimes this pain may be experienced in the lower back. There may also be visible varicose veins in the groin area, buttocks and upper thigh.
Often times our female patients have both leg varicose veins and pelvic varicose veins. Although these veins are in different locations both sources can be symptomatic to the patient. The question then becomes “which do I treat first?”
The problematic veins although similar in pathology and symptoms are treated in different methods. The legs are treated as an in office procedure involving the use of EVLA, sclerotherapy, and ambulatory phlebectomy. The pelvic veins are treated with a same-day hospital procedure called a venogram with coil embolization. The goal with both procedures is to close down incompetent veins that cause the symptoms. And while these are very different procedures often both procedures need to be performed to reduce the symptoms. The question of which procedure to do first really comes down to which problem is causing you the most pain.
Patients will often experience significant bruising, significant redness and a feeling of warmth in the areas of treatment. These issues will typically resolve within one to two weeks. You may also experience bleeding from a phlebectomy site. This can be quite significant. If you encounter bleeding or oozing, apply moderate constant pressure for five minutes. Hard focal lumps under the incision sites are also common to see after treatment. This can be a small segment of remaining vein or scar tissue from the incision that will soften up and dissolve over time. Once the steri-strips are removed you may notice a small fiber, like a strand of hair coming from the incision site. This is a small portion of dry tissue and you can trim this with a pair of scissors as close to the skin as possible.
Sclerotherapy uses ultrasound guidance to inject a medication into veins, causing scarring to occur and closing the vein permanently. This procedure is routinely used at IVC and patients want to know how this procedure compares to EndoVenous Thermal Ablation (EVTA) as far as pain caused during the procedure and recovery time after the procedure.
The sclerotherapy procedure often involves multiple injections along the course of the the problematic veins. Patients often ask if a local numbing agent could be used to anesthetize the area before the injection of the sclerosing agent. This technique is not used as this would require two needle sticks, one needle stick to inject a numbing agent and another needle stick to inject the sclerosing agent. In general most patients tolerate the sclerotherapy procedure well and do not need any anesthetic agent.
The post-procedure pain is usually localized to the area where the vein was injected. This pain is not nearly as intense as the pain following the EVTA but will be noticeable for longer. In fact it may take several weeks for the veins to be resolved by the body. During this time you may experience tenderness from these areas. A mild pain reliever like ibuprofen helps but really the biggest factor is giving the body time to resolve the treated veins.