What are stasis ulcers?

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.

What are Perforator Veins?

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.

How long will my treatment plan take?

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.

Why must I have an ultrasound after every procedure?

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.

What Are Varicoceles?

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.

How is Pelvic Congestion Syndrome Diagnosed and Treated?

Updated: October 2019

Pelvic venous insufficiency at IVC Interventional and Vein CenterPelvic Congestion Syndrome, also called Pelvic Venous Congestion, is a cause of chronic pelvic pain due to abnormally dilated varicose veins in the pelvis. Varicose pelvic veins develop when the valves in veins are not working correctly, causing blood to pool and pelvic vein distension. In some cases, pelvic venous congestion may also be due to obstructed blood flow from the pelvis. Similar to varicose veins in the legs, dilated or congested veins within the pelvis create pressure in the pelvis, vagina and pelvic floor. It is estimated that up to 30% of patients with chronic pelvic pain of an unknown cause actually suffer from symptomatic pelvic venous congestion.

As with all varicose vein disease, the causes of pelvic venous congestion are varied and complicated. Clinical research has shown the following associations:
● Genetic predisposition
● Multiple pregnancies
● Estrogen
● Polycystic ovaries
● Iliac or renal vein obstruction

Classic symptoms and signs of pelvic congestion include:
● Dull achiness and heaviness in the pelvis, often made worse by prolonged standing
● Pain in the lower back
● Visible varicose veins on the buttocks, vulva, and upper thighs
● Painful menstrual cycles with referred pain in the legs
● Increased frequency of urination
● Pain during and after sex

Since there here are many potential causes of pelvic pain, pelvic venous congestion unfortunately often goes unrecognized. As part of the assessment of patients with chronic pelvic pain, medical professionals may conduct multiple exams and tests such as:
● Pelvic exam
● Laparoscopy
● Pelvic and doppler ultrasound
● CT or MRI scans
● Pelvic venography

Pelvic ultrasound or other imaging studies such as CT are generally performed prior to treatment for pelvic venous congestion in order to exclude other possible pelvic disorders and to assess for anatomical variations which could affect treatment. It is important to note that a normal laparoscopy does not exclude the diagnosis of pelvic venous congestion.

The diagnosis of pelvic venous congestion is confirmed through an outpatient procedure called pelvic venography and treatment is typically carried out at the same time with a procedure called embolization. Embolization is a proven, safe and minimally invasive treatment option through which abnormal veins are closed using a combination of tiny coils and a sclerosing agent. Occasionally, pelvic venous congestion is caused by an obstructed iliac vein in the pelvis. In these cases, a stent may be required to open the abnormal iliac vein in order to restore normal flow out of the pelvis.

Treatment for pelvic venous congestion is performed in an outpatient setting and patients are discharged shortly after the procedure, typically returning to normal daily activity the same day. Approximately 85 percent of women with pelvic venous congestion will experience a significant improvement in their symptoms after appropriate diagnosis and treatment.

If you are interested in this treatment or have questions, please call 801.379.6700 or send us a message.

Resources:
Black, C.M. and Dillavou, E.D. “Endovascular Treatment for Pelvic Venous Congestion Syndrome.” Master Techniques in Surgery – Vascular Surgery: Hybrid, Venous, Dialysis Access, Thoracic Outlet and Lower Extremity Procedures. Ed. R. Clement Darling III, Ed. C. Keith Ozaki. Philadelphia. Wolters Kuwer, 2016, pp. 127-134. Print.

https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pelvic-congestion-syndrome.html
https://stanfordhealthcare.org/medical-conditions/womens-health/pelvic-congestion.html

What Is Pelvic Congestion Syndrome?

Pelvic Venous Embolization

What Is Pelvic Congestion Syndrome?

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.

What should I address first, my pelvis or my legs?

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.

 

There is not a 100% right or wrong answer to this question and so mostly it is a judgment call on the patient’s part. There are a few cases where the doctor may have a reason to treat one problem over the other but this is because it will be in the patient’s best interest.

What Should I Expect After Ambulatory Phlebectomy?

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.

Will My Sclerotherapy Procedure Be Painful?

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.