10 to 35% of adults in the United States have some form of chronic venous insufficiency (CVI), with venous ulcers also affecting 4% of people over the age of 65. Due to the high prevalence of the venous disease, the population based cost to the US government is over $1 billion a year. In addition, 4.6 million workdays per year are lost to vein-related illnesses.
Chronic venous insufficiency (CVI) is a condition that affects the veins of the lower extremities, resulting in high pressure within the veins, causing pain; swelling; edema; and skin changes including increased pigmentation, loss of hair, skin thickening, scaly skin, eczema, and finally skin ulceration. The human body consists of zillions of cells which are living organisms, and they require oxygen and nutrients to survive. The heart pumps the well-oxygenated blood to the tissues, and the cells take up the nutrients and return waste products, including carbon dioxide, into the veins, thus causing the bluish color of the veins. Now, this old blood has to return to the heart so that it can be pumped back to the lungs to get rid of the carbon dioxide and obtain oxygen. Leg muscles contain the only pump, called the musculovenous pump that returns the old blood against gravity from the feet and legs to the heart.
There are also one way valves in the veins to guarantee the direction of the blood from the legs towards the heart. These vales can stretch due to multiple factors and become incompetent, thus causing two way flow. When this happens, the increased pressure within the veins is related to the height of the column of blood from the level of the heart to that of the veins in the legs. This increase in pressure in the veins causes changes within the tissues including swelling, skin edema, the rash, dryness, pigmentation around the ankles, loss of leg hair, varicose and spider veins, hardening of the skin and finally ulceration. One of the characteristics of CVI is heaviness of the legs, burning and stinging around the varicosities and the spider veins as well as night cramps.
To test for incompetent valves in the veins we carefully obtain medical history, with particular reference to family history of varicose veins, injury and damage to the limbs, history of pregnancy and confirmation of previous surgeries, hormone use, obesity and clot formation.
To test for chronic venous insufficiency after full examination and inspection of extremities and observation of the obvious changes in the limb, we perform venous evaluation with ultrasound so that we can visualize the incompetent valves as well as measure the reflux across these valves and the size of the abnormal veins under the skin in the muscles and communicating systems. These computerized measurements will tell us whether the valves are incompetent or not.
The treatment for the incompetent valves is laser closure of the unhealthy superficial and communicating veins. The tortuous superficial veins are treated with chemical foam. These procedures are performed in the office as ambulatory procedures. Patients can go home the same day and continue their daily activities, with minimal pain, discomfort and inconvenience.
Dr. Hormoze A. Goudarzi is celebrating 32 years of surgical service to the community.
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