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VARICOSE VEINS:

 

Introduction to varicose veins:

Varicose veins is a condition that appears when the veins become dilated and overfilled, causing pooling of blood in the leg veins. These veins are enlarged because of accumulation of blood in them. They appear blue or purple in color. They are often raised, swollen and also painful. This is a common condition that affects approximately 25 percent of adults suffer from varicose veins and it is mostly present in women. Varicose veins usually appear in lower part of legs.

 

What causes varicose veins?

Appropriate functioning of veins is essential for the maintenance of blood flow from the legs and other parts of the body back to the heart. When veins are not functioning properly, there is pooling of blood in the legs, which leads to varicose veins. The exact cause of varicose veins is not completely known but it is believed to be the result of weakness of valves that are present in the superficial, deep and perforated veins.

This weakness of the valves leads to poor circulation of blood. The blood flow in the veins is not properly maintained because of this condition. These valves are damaged and therefore fail to assure that blood flow is properly maintained in one direction. This causes backward flow of blood, thus leading to the pooling of blood in the legs.

Pooling of blood in veins may also happen in some cases because of weakness in the walls of veins. Due to the weakness in the vein walls, the volume of blood in the vein increases to a great extent. This increased volume can also lead to varicose veins.

There are some instances when certain kinds of diseases may increase chances of a person to acquire varicose veins. Inflammation of veins, also called as phlebitis, can lead to venous disease. In addition to this, obstruction created by blood clots in veins may lead to insufficient flow. Other congenital abnormalities may also cause varicose veins in certain patients.

Some other causes of varicose veins can be:

  • Menopause
  • Excess of female hormones
  • Age above 50 years
  • Pregnancy
  • Family history
  • Genetics
  • Being obese or over weight
  • Sedentary life style – prolonged standing or sitting

 

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By National Heart Lung and Blood Institute. – Varicose veins., Public Domain, https://commons.wikimedia.org/w/index.php?curid=6885995

 

What are the symptoms of varicose veins?

The symptoms of varicose veins are variable. They may cause the legs to be swollen and painful. There may be some achiness, heaviness around the enlarged veins. Discoloration can also occur with swelling. In some cases, varicose veins can decrease oxygenation circulation to the tissues leading to ulcers and some instances they bleed.

With time, varicose veins may become more severe. But, if necessary changes in life style are made then there are chances of prevention of further medical problems. Physicians can suggest many different methods of approach for their treatment. Interventions including medications, venous ablations, sclerotherapy and surgery can result in reduced symptoms.

 

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By Blausen Medical Communications, Inc. – Donated via OTRS, see ticket for details, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=26986824

 

How do you diagnose varicose veins?

Doctors diagnose varicose veins by undertaking a thorough examination of a patient’s legs. Questions may be asked about any kind of pain or other symptoms that patients might have, such as swelling and itchiness. Patients are also asked about their family history, and the duration of presence of this condition. Doctors may want to know if the condition worsens with time and if the varicose veins appear to be expanding. Other medical conditions that a patient may have are also noted. Patients are asked to stand for five to ten minutes. This makes veins more visible as blood flow to the legs increase. This helps doctors make their assessment properly and thoroughly.

Ultrasound may be needed to check for appropriate flow of blood. This test is preferred as it is non-invasive and painless. The ultrasound test works by using sound waves to determine the direction of blood flow.

Further assessment of varicose veins can be done with the help of a venogram. A venogram is similar to an x-ray test. It utilizes a special dye that is injected to make the leg veins more visible. This test also helps to determine if there are other disorders of the leg, such as blocked arteries or blood clots or compression of the deep veins.

 

What are the treatment options for varicose veins?

The initial treatment of varicose veins is lifestyle management. Certain changes that doctor may advice include:

  • Maintaining a healthy weight
  • Weight loss if obese or overweight
  • Use of compression stockings, which apply pressure to ankles and calves thus increasing blood flow towards the heart
  • Moderate exercise that can help improve circulation of blood
  • Avoiding standing or sitting for a long time periods

These changes can help prevent the formation of new varicose veins as well. Compression stockings are the best non-invasive treatment option because they help to increase blood flow to the heart, thereby reducing leg swelling. Compression stockings can be bought in in drugs stores without a prescription. But this is only a temporary solution.

If lifestyle changes fail to improve varicose veins, the doctor may recommend venous ablation or sclerotherapy or surgical treatment depending on the severity of the disease. The various treatment options are:

Microsclerotherapy: This involves a liquid chemical injection that is used to block smaller veins. Laser energy is used to eliminate blockage in the veins

Sclerotherapy: A foam or liquid chemical injection is used, particularly for larger veins

Endoscopic vein surgery: A small scope with light is inserted and small incision is done to block off the diseased veins

Endovenous ablation therapy: Heat waves and radio frequency are used to eliminate blockages in veins

The best treatment option is determined by the physician after taking into account the risks and benefits of the procedure, size, location and condition of the varicose veins.

 

 

If you need more information on varicose veins – please call Champion Vascular Care at 910 304 1212 and talk to Dr. Ramaraj.

 

 

 

  • CHRONIC VENOUS INSUFFICIENCY:

 

What is chronic venous insufficiency?

Blood flows back to the heart from legs and various organs of the body through veins. In the lower limbs, calf muscles in legs and muscles in the feet contracts to push the blood in the upward direction towards the heart. Veins have one-way valve that allow blood to flow upward direction only. In some cases, when the valves of leg’s veins are not effectively working, they fail to return blood back to heart. Blood starts to pool in the veins resulting in stasis that result in condition called chronic venous insufficiency (CVI). About 40 percent of people living in the United States are affected by CVI. Females and aged individuals are more susceptible are a victim to this health problem.

 

When does CVI happen?

Damage in the valves of veins results in the backward leakage of blood. There are a number of causes of venous insufficiency and they include aging, extended periods of standing or sitting and reduced mobility due to orthopedics ailments. A combination of reduced mobility and aging also makes a person susceptible to CVI. Valves in the veins are weakened to a level where flowing up of blood to heart is not possible due to backward flow of blood and pooling of blood in the legs. Consequently blood pressure in the veins remains high, leading to chronic venous insufficiency.

In certain cases, blood clots form in the deep veins in the leg, condition called DVT or deep vein thrombosis. Chronic venous insufficiency occurring as a result of DVT is also called as post-thrombotic syndrome. Chronic venous insufficiency is a problem more common in individuals with DVT. About 30 percent people who experience DVT in any stage of their lives suffer from CVI.

Vascular malformations as well as pelvic tumors can also lead to CVI. There are some unknown factors that can lead to this condition. Any condition that causes sluggish movement of blood from of the veins towards the heart predisposes factor to CVI.

 

What are the risk factors?

Deep venous thrombosis

Family history of varicose veins

Inactivity or sedentary life style

Pregnancy

Obesity

Sitting or standing for extended time period

Smoking

Female sex

Age above 50 years

 

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By Ravipeenya (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

 

What are the diagnostic techniques used to diagnose CVI?
Doctor first does a non-invasive testing after taking history and undergoing physical examination. Visual evidence of chronic venous disease is identified by inspection and palpitation. Irregular bulges are also seen on the surface of skin. There can be ulcers present in the legs which can lead to scaring, in some individuals there can be hyperpigmentation, stasis and lipodermatosclerosis. Other reasons causing swelling such as deep vein thrombosis and systemic reasons of edema needs to be excluded.
Deep vein thrombosis (DVT) is diagnosed using venous duplex imaging. Severity and extent of the DVT can be confirmed with this technique. Invasive techniques such as venogram are sometimes used for diagnostic purposes when disease severity needs to be investigated and when interventions are being decided.

What are the treatment options of CVI?

There are a number of treatment options for CVI but usually physician recommends a combination of treatments. First patients are advised to avoid sitting or standing for long time period. If someone has to do so, then advised to flex and extend the ankles and feet occasionally. This helps movement of blood and pooling of blood in the leg in decreased. Frequent breaks are recommended in cases when someone has to stand for a longer time period. Physicians also advise patients to take regular exercise to improve blood circulation. Frequent walking and weight loss is helpful in this situation.

Leg elevation while sitting down or standing is also advised. In addition to this, compression stockings help to reduce the leg swelling.

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By James Heilman, MD (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

What are the medications prescribed by the doctor?

In some situations antibiotics help to get rid of skin infections and good skin hygiene is also recommended. It is also critical to treat the underlying disease such as DVT, compression of the deep veins a condition called May Thurner Syndrome that may give rise to deeper ulcers.

Blood thinning medications may also be prescribed that help reduce additional blood clotting and improve healing of ulcers in patients with DVT.
Why do I need to wear compression stockings?

Patients are advised to wear compression stockings. These stockings help the blood flow in the upward direction. This also helps to reduce the venous pressure, swelling and enhances healing of the venous ulcers. It is important to remove them at the end of the day when going to sleep. Along with this a good skin care is also necessary. Patients are asked to keep their skin moisturized all day. If skin is kept dried, there is an increased chance of infection, because it will crack and flake easily.

 

What are the less invasive treatment options for CVI?

There are surgical and non-surgical options available for the treatment of CVI. Some non-surgical treatments for CVI include sclerotherapy and endovenous thermal ablation. Injection of solution in the veins is done and this causes disappearance and collapse of abnormal veins. In Endovenous thermal ablation intense local heat is created.

Sclerotherapy:

Injection of solution in the veins is done and this causes disappearance and collapse of the damaged veins.

Endovenous thermal ablation:

Commonly two types of thermal ablation techniques have been utilized. One is radiofrequency and the other is laser ablation. Intensive local heat is created to melt the damaged veins and blood is re-routed to the normally functioning veins.

Venous stenting:

In patients who have compression of the deep iliac veins, sometimes called May Thurner Syndrome can be diagnosed by x-ray guidance venogram and venous stenting is done to improve the blood flow towards the heart.

 

What are the surgical treatment options for CVI?

About 10 percent of the patients of CVI need surgical interventions. This decision is made when non-invasive techniques prove to be less effective. Following options are generally used:

Ligation and stripping:

Litigation and stripping can be performed together or separately. During litigation cuts are made in the problem veins and these veins are tied up. Recovery may happen after few days. In stripping removal of larger veins is done with small incision.

Ambulatory phlebectomy:

In this technique, problem veins are removed with incisions with the help of phlebectomy hook.

Vein bypass:

This technique is similar to heart bypass. Healthy veins from other body areas are transplanted in the problem area with which blood is re-routed around the affect part. This technique is most commonly applied in upper thigh and is used in severe cases when no other treatment is effective.

 

If you need more information on chronic venous insufficiency– please call Champion Vascular Care at 910 304 1212 and talk to Dr. Ramaraj.

 

  • SPIDER VEINS:

 

What are spider veins?

Spider veins or telangiectasia is a skin condition that may occur in otherwise healthy individuals. In some cases, this problem may be a sign of serious underlying disease. The main cause of this disease is not well known, but it is believed that there are some genetic or environmental factors that may interact to cause this problem. Long term exposure to sun, heat or cold can also result in spider veins.

Telangiectasia is a benign skin condition that is usually not life threatening. Treatment is usually done to improve the appearance and outlook of the skin. Protection of skin from sun and extreme temperatures is also helpful. Small blood vessels are widened after which thread like redness is created in the area. This process happens gradually and clusters of veins are made. They are called as ‘spider veins’ because of the web-like appearance they make.

 

What areas are affected?

Most commonly spider veins or telangiectasia affects the exposed body areas. These areas include fingers, check, eyes, lips and nose. In most of the cases people find them unattractive and feel discomfort with them. This is the reason for which many of them opt to remove them. Telangiectasia is benign but it may be a sign of some kind of illness as well. There is a rare genetic condition called hereditary hemorrhagic telangiectasia (HHT) may be associated with spider veins.

image019

By M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

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By Herbert L. Fred, MD and Hendrik A. van Dijk (http://cnx.org/content/m14900/latest/) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

 

What are the symptoms of spider veins or telangiectasia?

Telangiectasia develops gradually with time and is usually not life-threatening in nature. However sometimes, people find their appearance gross or may want to get rid of them because of pain or bleeding. There are certain beauty products that can deteriorate them as well. Some abrasive sponges and soaps can cause irritation leading to further issues.

Basic symptoms of telangiectasia include pain because of pressure on venules or small veins. In addition, thread like red marks or skin pattern and itching sensation may also occur.

When a patient has underlying condition hereditary hemorrhagic telangiectasia (HHT) then they may experience symptoms that include shortness of breath, nose bleeding, seizures, black blood in stool and stroke.

 

What causes spider veins or telangiectasia?

There can be different reasons leading to telangiectasia but researchers are still unable to find the exact cause of this disease. Some environmental and genetic factors may interact to cause this condition. Chronic sun exposure and exposure to extreme heat or cold can lead to this situation. There are other factors as well that include liver disease because of increase alcohol intake. Some women may experience this situation in pregnancy when pressure is placed on venules. Enlarged veins or rosacea in face may also result in a flushed appearance in nose and cheeks.

Some medication can also increase the risk of getting telangiectasia. People who habitually use corticosteroids may result in thinning and weakness of skin. Inflamed skin because of dermatomyositis in the underlying muscle tissue can also cause this problem. Furthermore, systemic lupus erythematosus causing high skin sensitivity to sun and high and low temperature may result in this condition.

 

What are the key risk factors of spider veins or telangiectasia?

Genetic factor can cause telangiectasia. There are five genes that are involved in hereditary hemorrhagic telangiectasia (HHT) development. People with this condition may receive one or two mutated genes. There are certain other risk factors of telangiectasia as well and they include sitting or standing for long time periods. High intake of alcohol and corticosteroid use, are some other factors that can make people susceptible to telangiectasia. Pregnant women may also develop telangiectasia because of increased pressure on venules. Furthermore, people aged above fifty years are more susceptible to this condition. There are certain skin conditions as well that may increase chances of Telangiectasia and they include dermatomyositis, scleroderma, rosacea or systemic lupus erythematosus.

 

How is the diagnosis of spider veins or telangiectasia done?

Clinical signs and symptoms are used to diagnose this condition. Telangiectasia is visible from the thread like patterns or lines that are present on skin. In some cases, there are some underlying disorders as well that doctors want to diagnose. Some diseases are also associated with telangiectasia and they include HHT that is the inherited disorder when spider veins are formed in vital organs of the body. This may result in excessive bleeding at some stage in life. In addition, Sturge-Weber disease is another disorder that may result in excessive susceptibility. Spider angiomas are another abnormal condition that leads to blood vessel collection near skin surface causing condition like telangiectasia.

 

What are the treatment options of spider veins or telangiectasia?

Basic treatment options are selected for bringing improvement in the appearance of skin. This may be done via various techniques. Nowadays laser is being employed to target vessels that are widened. This may cause a little pain but recovery time is short.

Invasive techniques such as surgeries may be used that involve removal of blood vessels from the problem area with incision. Sclerotherapy is also recommended in severe cases and is done by injecting medicated solution to the affected area. This helps blood clot removal and also eases thickness, scar and collapse of small veins. In case of HHT laser therapy, surgery and embolization is used. After treatment the outlook of skin with spider veins improves. People after treatment can lead a normal life after this problem is solved by surgery and laser.

 

 

If you need more information on spider veins – please call Champion Vascular Care at 910 304 1212 and talk to Dr. Ramaraj.

 

 

 

 

 

 

 

 

 

 

  • CRITICAL LIMB ISCHEMIA:

 

What is critical limb ischemia?

Critical limb ischemia (CLI) by definition is a severe artery blockage in the lower extremities. This causes reduced blood-flow in the arteries. It is one the most serious condition in the stages of peripheral arterial disease (PAD). This disease is a consequence of atherosclerosis or fatty deposits. Atherosclerosis is characterized by narrowing and hardening of arteries over time. The major cause of atherosclerosis is the buildup of fatty deposits on the arterial walls which is referred to as plaque.

 

What happens in critical limb ischemia?

In critical limb ischemia, the patients constantly feel pain in the feet and toes not only on walking but also while resting. Poor circulation of blood in the lower limb leads to a number of complication that include wounds and sores. If the condition persists, the wounds in the legs or feet won’t heal. The wounds if left untreated may result in amputation of the affected limb.

 

What are the symptoms of critical limb ischemia?

One of the most common symptoms that patient with critical limb ischemia display is called ischemic rest pain. This condition is characterized by extreme pain in the legs and feet at rest. Patient goes through the same amount of pain even while not active. This happens because of non-healing sores on the feet and legs with reduced oxygen to the dying tissues. Some of the prominent symptoms of critical limb ischemia include:

  • Pain in the feet and calf
  • Numbness in the feet
  • Coarse, dry, shiny and smooth skin of affected legs and feet
  • Thickened toenails
  • Absence of pulse in the legs or feet
  • Non- healing skin infection and ulcers
  • Dry gangrene

 

What are the risk factors associated with critical limb ischemia?

Risk factors for chronic limb ischemia are similar to those for atherosclerosis, which include hardening and narrowing of the arteries due to the accumulation of fatty deposits in the arteries called plaque. Some of the risk factors associated with critical limb ischemia are

  • Family history of atherosclerosis or claudication
  • Diabetes
  • High cholesterol
  • Smoking
  • Age
  • High blood pressure
  • Sedentary lifestyle
  • Excessive weight gain or obesity

image023

CC-BY-3.0-RS, https://sr.wikipedia.org/w/index.php?curid=349443

 

How critical limb ischemia is diagnosed?

There are many ways by which doctors identify the cause of blockages that result in critical limb ischemia (CLI). Some of these methods are listed below:

Auscultation:

This is one of the most common techniques used for the diagnosis of ischemia. In this technique doctors look for the presence of a bruit or whooshing sound in the arteries of the affected leg. Doctors confirm this whooshing sound and the presence of ischemia with the help of a stethoscope.

Ankle-brachial index (ABI):

Another diagnostic technique that the doctors use for ischemia is the ankle-brachial index. In this technique ratio between the pressures in the ankle and arm are measured to check for decreased blood flow in the legs.

Doppler Ultrasound:

Doppler Ultrasound is another common technique used for the diagnosis of ischemia. This technique is an effective way of measuring the direction and velocity of blood flowing through the vessels.

CT angiography:

CT angiography is an advanced form of X-ray procedure used for the diagnosis of ischemia. This technique makes the use of a computer system in order to create three-dimensional images.

Magnetic resonance angiography (MR angiography):

In MR angiography, a magnetic field and pulses of radio wave energy are used to create pictures. The energy released during this process is measured by a computer. These measurements are constructed into construct 2D and 3D images of the blood vessels.

Angiogram:

Angiogram is another way to view ischemic arteries. It is basically an X-ray study of the blood vessels which are taken using contrast dyes.

 

What are the treatment options for critical limb ischemia?

Critical limb ischemia is a severe case of peripheral arterial disease. It needs immediate treatment in order to re-establish the flow of blood to the affected area. The first priority of the doctor is to preserve the limb. There are two treatments available one is endovascular treatment and other is traditional open surgical treatment otherwise called bypass surgery.

 

What is the non-surgical treatment for critical limb ischemia?

Doctors initially use a minimally invasive endovascular therapy to treat chronic limb ischemia (CLI). The treatment recommended in this condition basically depends on the severity of the condition as well as its location.

A large number of patients who suffer from CLI have multiple arterial blockages. These blockages also include blockages below the knee. This treatment option involves puncturing the groin or arm, under local anesthesia. In this process a catheter is inserted into the artery in the groin or arm. Doing so provides an access to the diseased portion of the artery. A few of the endovascular procedures used to treat CLI are listed below:

Angioplasty:

In this procedure a tiny balloon is inserted into the artery through a puncture in the groin or arm. The inserted balloon is blown one or more times with a saline solution in order to open the artery.

Cutting balloon:

This procedure involves the use of a balloon imbedded with micro-blades. This technique is used to enlarge the diseased area. The blades on the balloon are used to cut the surface of the plaque. This reduces the force required to stretch the vessel.

Cold balloon (Cryoplasty):

In this procedure nitrous oxide is used to inflate the balloon instead of saline. The purpose of this gas is to freeze the plaque. Freezing the plaque halts its growth with the generation of a little scar tissue.

Stents:

This treatment option uses metal mesh tubes. These tubes are designed to provide scaffolding to the narrowed walls of the artery. These mesh tubes are left in place after an artery has been dilated using the procedure of a balloon angioplasty.

image025

By BruceBlaus (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

 

Balloon-expanded stents:

In this technique a stent is mounted on a balloon is used to help to deploy the stent in the blocked artery. These stent mesh tubes are durable but less elastic.

Self-expanding stents:

Compressed stents are transported to the diseased site using catheters and wires. These stents enlarge upon release and are comparatively more flexible.

Laser atherectomy:

In this procedure a laser probe is used. The tip of the laser probe is used to vaporize small bits of the plaque.

Directional atherectomy:

In this procedure the plaque is physically removed from the artery. This is done using a catheter with a rotating cutting blade. This technique is allows the opening of the flow channel.

 

What are the surgical treatments options for CLI?

The wounds and ulcers resulting from CLI cannot be left untreated. These require surgical procedures or some other follow-up care options. These surgical treatments are recommended if the arterial blockages are not favorable for endovascular therapy. These treatments typically involve bypass around the diseased segment. This segment is usually bypassed using a vein from the patient’s body or by a synthetic graft.

 

If you need more information on chronic limb ischemia – please call Champion Vascular Care at 910 304 1212 and talk to Dr. Ramaraj.

 

 

 

 

  • PERIPHERAL ARTERIAL DISEASE:

 

Peripheral arterial disease (PAD) is one of the most common circulatory problems. In this condition artery of the limbs get narrowed that result in the reduction blood flow to the limbs.

 

What happens in PAD?

When a person develops peripheral artery disease (PAD) in the extremities, mostly legs don’t receive enough blood flow to meet the oxygen demand. The notable symptoms of this disorder include pain in leg while walking. This symptom is also referred as claudication.

Peripheral artery disease is an indication of accumulation of fatty deposits in the arteries of your limbs. This buildup of plaque in the arteries is referred to as atherosclerosis. In this condition the blood flow to heart brain and legs are reduced.

Peripheral artery disease (PAD) can be successfully prevented by:

  • Quitting tobacco
  • Working out
  • Eating healthy
  • Losing weight
  • Taking care of diabetes

 

What are the symptoms of PAD?

Most of the people with peripheral artery disease display mild or no symptoms. However, some people complain having pain in the leg while walking. This condition is termed as claudication.

The symptoms Peripheral artery disease includes:

  • Painful cramps in lower limbs specifically on hip, thigh or calf muscles after getting involved in a strenuous physical activity.
  • Numbness or weakness in legs
  • Coldness in your lower extremities.
  • Noticeable sores and wounds on your toes, feet or legs that don’t heal
  • Discoloration of the affected area on the leg
  • Slower or reduced hair growth on the affected limb
  • Reduced growth of your toenails
  • Shiny, smooth and dry leg skin
  • No or a weak pulse in the affected limb
  • Erectile dysfunction in men

If peripheral artery disease persists, then the patient feels pain even at rest or while lying down. This pain is referred to as ischemic rest pain. Sometimes the pain gets so intense it disrupts your sleep. Some of the ways to relive this pain include hanging your legs over the edge of your bed as well as walking around the room.

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By National Heart Lung and Blood Institute – http://www.nhlbi.nih.gov/health/health-topics/topics/pad/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=25539713

 

 

When to visit the doctor?

Don’t dismiss having leg pain, numbness and other symptoms of PAD as a normal part of aging. Contact your doctor as soon as possible to make an appointment.

Even if you don’t display the symptoms of PAD, it’s necessary for you to get screened for this condition especially if you are:

  • Over the age of 70 years
  • Over age the of 50 years and have a family history of diabetes or smoking
  • Below the age of 50 years and have diabetes or other peripheral artery disease risk factors, including obesity or high blood pressure.

 

What are the causes of PAD?

Atherosclerosis by definition is the buildup of fatty deposits on the walls of the arteries that result in the reduction of blood flow. These fatty accumulations are also known as plaque.

Although atherosclerosis is directly associated with the proper functioning of the heart, it however affects the arteries of the entire body. When this condition occurs, the arteries transporting blood to the limbs develop peripheral artery disease.

A few of the less frequent causes of peripheral artery disease could be:

  • Inflammation of the blood vessel
  • An injury to the limbs
  • Rare anatomy of ligaments or muscles
  • Exposure to radiation

image029

By United States: Centers for Diseases Control and Prevention (http://www.cdc.gov/heartdisease/coronary_ad.htm) [Public domain], via Wikimedia Commons

 

 

 

 

 

 

What are the risk factors associated with PAD?

Some of the factors that contribute towards increasing the risk of development of peripheral artery disease are:

  • Smoking
  • Obesity
  • High blood pressure
  • Diabetes
  • High levels of cholesterol in the blood
  • Old age
  • Family background and genetics of peripheral artery disease, stroke or heart disease
  • Elevated levels of homocysteine protein component
  • Reduced blood flow resulting from smoking or diabetes.

 

What are the complications associated with PAD?

If peripheral arterial disease (PAD) is the result of the accumulation of plaques in your blood vessels then you are at a high risk of developing critical limb ischemia (CLI). This condition is characterized by non- healing open ulcers that are caused by an injury or infection on your feet and leg. This open sore can lead to tissue death (gangrene), which sometimes requires the amputation of the affected limb.

The atherosclerosis isn’t limited to your legs. Plaque built up in arteries supplying your heart and brain leads to an even more severe situation like a stroke or heart attack.

 

How PAD is diagnosed?

The diagnosis of PAD starts with physical examination. Your doctor might inquire you about symptoms you have been experiencing. Then your doctor will check your affected leg for weak pulses. There are a variety of procedures dedicated to the diagnosis of PAD. Some of these procedures are listed below:

Ankle-brachial index (ABI):

This procedure is a painless examination of artery in which the blood pressures in your legs are compared to the blood pressure in your arms. This is an effective way to determine if your blood is flowing at a normal rate. If an ABI provides an abnormal ratio between the blood pressure of the upper and the lower limbs, you may require taking more tests.

Doppler and Ultrasound (Duplex):

This procedure is a non-invasive way to picture the artery using sound waves. This procedure is an effective way to measure the blood flow in an artery and to locate a blockage.

Computed Tomographic Angiography (CT):

This test is a non-invasive way to image the arteries of your abdomen, pelvis and legs. This test is specifically designed for the patients with pacemakers or stents.

Magnetic Resonance Angiography (MRA):

This test is a non-invasive procedure to acquire results similar to that of a CT without the use of X-rays.

 

If you need more information on peripheral arterial disease – please call Champion Vascular Care at 910 304 1212 and talk to Dr. Ramaraj.

 

 

 

  • LEG SWELLING AND DARKENING OF SKIN IN VEIN DISEASE

 

Chronic venous disease by definition is a disorder that affects the veins of lower limbs of the patient. The veins that get affected are responsible for carrying blood from the legs to the heart. In veins there are number of valves that are present to guide and direct blood flow from the surface of the legs to deep inside the veins. This blood is then pumped back to the heart with the help of calf muscles. These valves are also responsible for controlling the pressure of blood in smaller veins that are present on the surface of leg.

 

What happens in chronic venous disease?

In chronic venous disease, the valves present in the veins stop working properly. Consequently, the blood flows backward in the veins and pools in the leg. This pooled blood increases the pressure of blood in the veins which can leads to a number of problems including:

  • Leg heaviness
  • Aching
  • Dilated or unsightly veins

Apart from these mild issues, there are number of severe problems that the unnecessary blood pooled in the legs can cause. These problems include:

  • Leg swelling
  • Discoloration of skin
  • Skin rash on the leg
  • Skin infections
  • Chronic ulcers

 

What are the causes of chronic venous disease?

When the pressure of blood abnormally increases in the veins of legs, it stretches the vein. The pressure exerted on the walls of the veins damages the valves that worsen the situation. Damaged valves can’t control the pressure of the blood entering the vein which eventually results in chronic venous disease leading to darkness and swelling in the area.

There are a number of problems that can increase the pressure of blood in veins. These reasons include:

Formation of clot inside a vein:

When a clot is formed inside a vein, it blocks the blood flowing through it. In this condition pressure builds up in the vein causing permanent damage to the vein and valves. This condition persists even after the clot has dissolved.

Leg injury or surgery:

Sometimes an injury can block the flow of blood through a vein. Even a surgery can block the flow of blood through a vein and increases pressure. This results in chronic venous disease.

Excess weight gain:

Obesity is considered one of the most evident causes of chronic venous disease. Excess weight gain during pregnancy can also increase pressure in the veins of leg eventually damaging the veins and valves.

Standing or sitting for prolonged periods:

If you remain seated or stand for prolonged period of time without walking, it can result in decreased movement of blood out of the leg. This condition eventually leads to chronic venous disease as the pressure of blood in the veins increases and blood pools in the vein. This happens because leg muscles play a vital role in the circulation of blood. These muscles basically act as a pump and move blood from the legs back to the heart.

 

What are the symptoms of chronic venous disease?

Chronic venous disease results in:

  • Enlarged veins:

Dilated veins are the most common feature of venous disease. These stretched veins either appears as thin blue flares that look like a spider web or enlarged twisted veins that bulge on the surface of the leg. Thin blue veins resembling spider web and called as spider veins and the ones that twist and dilate are called varicose veins.

  • Swelling:

One of the most frequent symptoms of chronic venous disease is a swollen leg often referred as edema. This condition prevails when you spend a lot of time standing. Your ankles and lower legs swell. Most of the times, swelling is only visible at the end of the day. Other times it is present throughout the day. Leg elevation decreases swelling that’s why is least prominent during the day time.

image031

By self – self, Public Domain, https://commons.wikimedia.org/w/index.php?curid=11347155

 

  • Skin discoloration:

When the pressure in veins of legs increases, it leads to blood pooling that eventually turns the skin red. If the condition persists over years, the skin color permanently changes to tan or a reddish-brown. Changes in the color of skin are initially visible around the ankle, but frequently spread over the shins and on the foot.

 

image033By Nini00 [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

 

  • Venous ulcers:

Venous ulcers are another major consequence of chronic venous disease. This disease cause non-healing sores that are often referred as chronic venous leg ulcers or venous stasis ulcers. These ulcers often appear on the inner ankle and eventually spread on the outer ankle as well as in the shin area. These ulcers neither appear above the knee nor on the foot or the toes. If a venous ulcer appears higher on the leg, it is often the result of an injury or trauma for example from repeated scratching. Multiple ulcers can occur at a time.

 

How chronic venous disease is diagnosed?

Venous disease is usually diagnosed by examining the patient for signs and inquiring about symptoms of the disorder. Patient is examined for the occurrence of varicose veins, swelling in the legs, skin rashes and discoloration as well as skin ulcers. A number of additional tests are also conducted that include ultrasound that enables the doctor to examine vein valve function. This helps him to identify if the problem is located in the superficial veins or the deep veins.

 

What are the treatment options for chronic venous disease?

The treatment of this disorder mainly focuses on the reduction of the symptoms. These treatments include treating swelling, treating skin rashes and discoloration and prevention of ulcers. Some of the treatment options are listed below.

Leg elevation:

Leg elevation is one the most effective was to reduce swelling on the leg. You may need to elevate your leg above the heart level three to four times a day for 30 minutes or so. This technique improves the blood flow and reduces inflammation on the leg.

Exercises:

Foot and ankle exercises are commonly recommended for the effective reduction in the symptoms.

Compression therapy:

Compression therapy using compression stockings, intermittent pneumatic compression pumps and compression bandages is considered an essential treatment for chronic venous disease.

Medications:

A number of medications have been recommended for relief from the symptoms of chronic venous disease and venous ulcers. These medicines include:

  • Aspirin (300 to 325 mg/day)
  • Antibiotics
  • Horse chestnut seed extract
  • Hydroxyethylrutoside

Sclerotherapy:

Injection of solution in the veins is done and this causes disappearance and collapse of

the damaged veins.

Endovenous thermal ablation:

Commonly two types of thermal ablation techniques have been utilized. One radiofrequency and the other is laser ablation. Intensive local heat is created to melt the damaged veins and blood is re-routed to the normally functioning veins.

Venous stenting:

In patients who have compression of the deep iliac veins, sometimes called May Thurner Syndrome can be diagnosed by x-ray guidance venogram and venous stenting is done to improve the blood flow towards the heart.

 

If you need more information on leg swelling and darkening of the skin – please call Champion Vascular Care at 910 304 1212 and talk to Dr. Ramaraj.

 

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