VASCULAR SOLUTIONS - Vascular and Endovascular Surgeons Treating Peripheral Vascular Disease in Cleveland, Ohio

Vascular Solutions

Deep Venous System Disease Treatments

If the deep system is incompetence, regardless of the status for the superficial system, surgical or sclerotherapy is not appropriate. Deep system incompetence must be treated with conservative therapy. Conservative therapy consists of reducing the leg edema. Thus things that help with draining fluid back to the heart are useful measures. The slogan "water runs down hill" helps remind patients that if there legs are in a dependent position below their heart the edema will increase. Ideally the legs should be elevated above the heart when not walking. Walking is an exception for leg elevation, since for one thing, patients must live life and secondly walking involves the calf pump system discussed earlier in this venous section of the web site. Compression stocking are the gold standard of care. Often with the use of compression stockings, the best method for placing them on is before your feet hit the floor. If you wait until after you have been up for a while, your legs will have swelled, making the process that much harder. Use a moisturizer (hypoallegetic) at night. Moisturizers contain petroleum and other agents that will prematurely age the elastic, compression stockings. You must also recognize that the stockings must be replaced every 5-6 months even if they still feel "tight". They must be worn consistently, even during the hot summer months. Failure to comply will often result in skin inflammation and possible ulceration. One must bare in mind that with each episode of skin breakdown, scarring occurs. Such scarring injuries the subdermal plexus of lymphatics as well as makes the skin brittle and hard. The skin with each episode of inflammation, infection or ulceration becomes more susceptible for future skin breakdown. This cycle must be avoided!

Superficial Venous System Disease Treatments (Varicose Veins)

If the deep venous system is competent without evidence of reflux, then options become much broader. Certainly for some, conservative care with compression stockings (as described above) represents a nice means for treating their problem. The only problems with compression stockings are that they wear out and need replacement every 5-6 months even if they still feel "tight". During the winter months they are great, but during the hot summers, many patients will fail to wear them consistently and place themselves at risk for recurrence of symptoms and possibly ulcerations. If the greater saphenous main trunk is competent, then sclerotherapy is a good alternative. Sclerotherapy involves use of a very fine needle to inject a small amount of a very irritating solution into the vein. This causes the walls of the vein to "stick" together and to scar. thus preventing blood flow through the vein. If the main trunk of the greater saphenous vein is incompetent, however, sclerotherapy is not effective long term. Recurrences are frequent and thus Vascular Solutions would not recommend this therapy for such a patient. Vein stripping or vein obliteration represents an option for patients that do not find compression stockings acceptable. The main trunk of the greater saphenous vein is either anatomically removed or with newer methods the walls are "stuck" together using either laser or radiofrequency energy. These options will be covered each separately.

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