UNDERSTANDING VEIN PROBLEMS Varicose Veins, Chronic Venous Insufficiency, and DVT
Do You Have a Vein Problem? Have you noticed pain or swelling in your legs? Do your symptoms worsen when you re sitting or standing in one position? If so, you may have a vein problem. Some vein problems are simply cosmetic. Others can damage tissue or even cause blood clots. In these cases, treatment is needed right away. If you think you have a vein problem, contact your doctor. He or she can evaluate your veins and help you plan treatment if needed. Knowing If You re At Risk Vein problems can affect both men and women. Certain risk factors make them more likely. These include: Older age Family history of vein problems Sitting or standing for long periods Recent surgery Leg injury Previous blood clot in the leg Overweight or obesity Lack of physical activity Pregnancy Smoking Treatment Can Help Whether your vein problem is cosmetic or affects your health, your doctor can help you form a treatment plan that s right for your needs. This plan will likely include self-care and lifestyle changes. Depending on the problem, treatment might also include a procedure or medications. You and your doctor can discuss your options and their benefits and risks. Be sure to ask any questions you have and get the answers you need. 2
Diagnosing a Vein Problem Your doctor will evaluate the health of your veins. A health history and physical exam will be done. A special test called a duplex ultrasound may also be done. Using the results, you and your doctor can then review treatment options. Health History and Physical Exam Describe any symptoms you have to your doctor. These can include leg tiredness, aching, heaviness, swelling, or itching. Tell the doctor if your family has a history of vein problems. Also mention if you have had a blood clot, leg injury, recent surgery, or pregnancy. Your doctor will examine your legs for abnormal veins, swollen or tender areas, and skin color changes. Duplex Ultrasound Duplex ultrasound is an imaging test. It uses sound waves to form live images of veins and their blood flow. To perform the test, a handheld device is moved over the skin. Images of the veins are then viewed on a screen. This makes it possible to locate the source of a vein problem. During the test, you may be asked to move between standing and lying down. 3
How Blood Circulates With every heartbeat, blood flows from the heart to the rest of the body, then back to the heart again. This process is called circulation. Circulation depends on a complex system of blood vessels (arteries and veins). Arteries carry blood away from the heart. Veins return blood to the heart. When veins are damaged, they have trouble doing their job properly. This can lead to vein problems that range from mild to severe. Back View Femoral vein (deep vein) Great saphenous vein (superficial vein) Small saphenous vein (superficial vein) Side View Types of Veins The body s large network of veins works like a system of pipes to carry blood from the body back to the heart. Superficial veins lie just below the skin. They carry blood from skin and surface tissues. They drain into the deep veins, which lie in the muscles of the legs. Perforating veins help carry blood from the superficial veins to the deep veins. Skin Superficial vein Perforating vein Deep vein Muscle The great and small saphenous veins are the main superficial leg veins. Blood drains from superficial veins near the skin into larger deep veins that lie in the leg muscles. 4
How Leg Veins Work Veins and muscles must work together against gravity to move blood up the legs and toward the heart. When leg muscles contract and relax, they squeeze blood up the veins. Veins have special cuplike flaps called valves along their inside walls. These valves act as one-way doors. They open and close to keep blood flowing toward the heart. Veins with walls or valves that are damaged can t move blood the way they should. A Healthy Vein A healthy vein has strong walls and valves. When leg muscles contract, the valves open. This allows blood to be squeezed up the vein. When leg muscles relax, the valves close. This prevents blood from flowing backward in the vein. Valves are strong enough to hold blood in place until the muscles contract again. Valve open When a muscle contracts, the valve opens. Blood is squeezed up the vein. A Damaged Vein A damaged vein has walls that are weak and stretched (dilated). Also, the valves may be damaged and no longer close fully. This allows some blood to leak backward when leg muscles relax. If the valve can t close at all, the blood flows backward to the nearest healthy valve (reflux). This increases pressure on the healthy valve. Over time, the extra pressure weakens this valve and others below it. Blood begins to pool in the vein. Varicose veins may result. Swelling (edema) may develop in the leg. Also, blood clots may form in areas of the vein where blood moves too slowly or not at all. Damaged valve Valve closed When a muscle relaxes, the valve closes. This holds the blood in place. When a damaged valve can t close, blood moves in the wrong direction. This causes blood to pool lower in the vein. 5
Varicose Veins Varicose veins are a common vein problem. They occur when superficial veins become dilated and bulge under the skin. This can happen if vein walls weaken and valves don t close properly. Varicose veins often run in families. They may also develop during pregnancy. If varicose veins are a cosmetic concern or cause you discomfort, treatment can help. Symptoms of Varicose Veins Varicose veins stand out under the skin. They often appear as blue or green ropes behind the knees, and in the calves and thighs. Varicose veins can cause symptoms such as pain or discomfort. The legs may sting or ache during long periods of sitting or standing. Also, the ankles or feet may swell. If varicose veins worsen, skin damage or blood clots may develop. These more serious vein problems must be treated. Treatments for Varicose Veins With a varicose vein, blood flows in the wrong direction, causing symptoms. Varicose veins can be treated with self-care measures to help improve symptoms (see pages 12 through 15). Certain procedures can also be done, including endovenous ablation and microphlebectomy (see opposite page). These procedures either destroy or remove varicose veins. Blood then reroutes through other healthy veins. For each procedure, medication called anesthesia may be used to prevent pain. Damaged valve Dilated vein As blood presses on weak vein walls, the vein bulges beneath the skin. 6
Endovenous Ablation This procedure uses a heat source, such as radiofrequency (RF) or laser, to treat a problem vein. A small puncture is made in the skin with a needle. A thin tube (catheter) is then put into the vein and used to deliver the heat source. Once in place, the heat source is slowly withdrawn. This seals the vein behind it. You can go back to your normal routine soon after the procedure. Microphlebectomy This procedure is used to remove small varicose veins. Tiny incisions are made in the skin over the affected sites. A special hook is then used to remove the veins. Microphlebectomy may be done with other vein procedures. You can go home a few hours after the procedure. Recovery may take a few days or longer. Other Treatments In certain cases of varicose veins, the following treatments may also be options: Sclerotherapy. A special chemical is injected into the problem vein. This causes the vein to close up and dissolve. Ligation with stripping. One or both saphenous veins are tied off (ligated), then removed. Treated portion of vein Laser (heat source) RF catheter (heat source) Catheter With endovenous ablation, a heat source is used to seal off a problem vein. Risks and Complications Risks of endovenous ablation include: Severe bruising or bleeding Redness and swelling (inflammation) Skin burns Blood clot Nerve injury Risks of microphlebectomy include: Bleeding Infection Nerve injury Redness and swelling (inflammation) Blood clot 7
Chronic Venous Insufficiency Chronic venous insufficiency (CVI) is a condition that can occur if leg veins are too damaged and have trouble carrying blood back to the heart. It can lead to leg swelling, skin changes, and open wounds called venous leg ulcers. If your doctor suspects that you have CVI, testing will be done to determine the severity of the problem. You and your doctor can then discuss treatment options. Symptoms of CVI With CVI, blood flows backward through damaged valves and pools in the veins. Over time, the pressure in the veins gets too high. This can cause swelling in the legs, ankles, and feet. The skin can become inflamed, leading to dryness or itching. The skin may also take on a red or brownish pigment. Ulcers may form as well (see opposite page). Treatments for CVI Dry, itchy, discolored skin The goals of CVI treatment are to reduce symptoms and to prevent and treat complications, such as ulcers. Depending on your needs, treatment may include: Self-care, such as wearing compression stockings and elevating the legs (see pages 12 through 15). These actions help lower the pressure in the legs and reduce swelling. Procedures to destroy or remove a problem vein (see pages 6 and 7). Your doctor can tell you more about these treatments and other options you may have as needed. With CVI, blood pools in the lower legs and ankles. This can lead to swelling and damaged skin. Elevate your legs above heart level as directed by your doctor. This can help reduce swelling. 8
An ulcer can form where skin is severely damaged and breaks down. Damaged skin Ulcer Treating an Ulcer If you think you have an ulcer, see your doctor right away. Then follow all home care instructions your doctor gives you. In some cases, referral to a wound clinic that specializes in ulcer care is needed. Treatment for ulcers can include: Applying various types of dressings to the ulcer. These are usually moist and contain medications to improve healing. Dressings may need to be changed one or more times every week. Elevating your legs above heart level to reduce swelling. Wearing elastic compression stockings or bandages. These help improve blood flow and reduce swelling. Taking antibiotics to help treat skin Understanding Ulcers When high pressure and swelling are not controlled, CVI can worsen. Skin and surface tissues eventually break down. Ulcers can then form. This is a serious problem. Ulcers occur most often on the lower legs and ankles. They often seep watery fluid. Due to swelling and poor blood flow, ulcers can heal very slowly. In many cases, they require ongoing care. infections. An Unna boot is a common dressing used to treat an ulcer. An elastic bandage is often wrapped over the boot for added compression. This may help the ulcer heal faster. 9
Deep Vein Thrombosis Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein. Over time, the blood clot can grow large enough to block the vein. You do not need to have damaged veins to be at risk for DVT. It occurs most often when blood moves too slowly. Long periods of inactivity, such as during an illness, after surgery, or even during a plane flight, can lead to DVT. If part of the clot breaks off, it can travel to the lungs and lodge in an artery, causing a pulmonary embolism. This can be fatal if not treated right away. Symptoms of DVT DVT does not always cause symptoms. If you do have symptoms, they are likely to occur in only one leg. Possible symptoms include sudden ache or pain deep in the muscle. The leg may swell or feel tender. Also, the skin over the leg may turn red or feel warm. Treatments for DVT If DVT is confirmed, treatment is likely needed. The goals of treatment are to control the size of the clot and prevent more clots from forming. Medications are usually prescribed first. In certain cases, a procedure may be needed to dissolve a large clot or to reduce the risk of a pulmonary embolism. See the opposite page to learn more about these treatments. Embolus Blood clot A clot that breaks off is called an embolus. Clots tend to form when blood moves slowly, such as when you sit in one position for a long period. 10
Anticoagulants With DVT, anticoagulant medications are often the first line of treatment. Also called blood thinners, these medications help keep blood from clotting. You may be prescribed more than one kind of anticoagulant. These may be given by IV (intravenously), injection, or mouth. Your doctor will give you exact instructions on how to take the medications. Be sure to follow these carefully. Depending on the type of anticoagulant prescribed, regular blood tests may be needed to check how well it is working. Thrombolysis This procedure is used to dissolve a large clot. A thin tube (catheter) is put into the affected vein. X-rays are taken of the vein and of the clot. Then, special clot-dissolving medication is delivered directly to the clot through the catheter. If needed, a mechanical device may be used along with the medication to help break up the clot. Inferior Vena Cava Filter An inferior vena cava (IVC) filter is a small device used to trap a blood clot in the lower body. This helps prevent a pulmonary embolism from occurring. The filter is delivered by a catheter and placed in the IVC. This is the body s largest vein that returns blood from the legs to the heart. The filter may be permanent. Or it may be used only for a short time until the risk of pulmonary embolism has passed. It may then be removed. Risks and Complications Risks of thrombolysis include: Bleeding Infection Blood clot may travel to another part of the body Risks of placing an IVC filter include: A blood clot may form at the location of the filter Bleeding Infection Damage to the vein Loosening or movement of the filter from its original location 11
Compression Stockings No matter what type of vein problem you have, you can take steps to manage symptoms and reduce your risk of further problems. Elastic compression stockings are prescribed to treat all vein problems. Your doctor will help you learn how to use them. Compression Stockings Compression stockings fit snugly around the ankle, gradually reducing in pressure as they go up the legs. This helps keep blood flowing toward the heart, so it s less likely to pool in the legs. Compression stockings come in many styles, lengths, and sizes. They also come in different degrees of pressure. Do not buy them without first seeing your doctor. He or she will prescribe stockings at a safe and effective pressure for you. For best results, wear the stockings exactly as directed. How to Put On Compression Stockings 1 2 Turn the stocking inside out, then fit it over your toes and heel. Roll the stocking up your leg. 12
Tips for Wear and Care Wear the stocking length and pressure prescribed by your doctor. Pull stockings to the designated height and no farther. Don t let them bunch at the top. This can restrict blood flow and increase swelling. Also make sure the stockings have no folds or wrinkles. Remove the stockings at least once a day. Check your skin for changes in color, bruising, or sores. If you see skin changes, call your doctor. Replace stockings when they start to feel loose. This is likely to be every 3 to 6 months. Wash stockings as instructed. They may need to be hand-washed. 3 Stocking donner To make it easier to put on compression stockings, use equipment such as a stocking donner or wear rubber gloves. Once stockings are on, make sure the tops of the stockings are about 2 fingers width below the creases of the knees (or the groin, if you wear thigh-high stockings). 13
Other Self-Care for Vein Problems Along with compression stockings, the self-care measures on these pages can help reduce symptoms and improve the health of your veins. They are also an important part of home care after any procedure. Talk with your doctor to learn more. Elevation Elevation keeps blood from pooling in the leg veins. This lowers the pressure in the legs and helps reduce swelling. Raise your legs above heart level for about 30 minutes, 3 to 4 times a day. This works best if you lie flat on your back. You may want to use a few blankets or pillows to prop up your legs. Put your feet up while you do sit-down tasks. Elevating at hip level doesn t reduce swelling, but it may help keep it from getting worse. Clot Prevention Sitting or standing for long periods can worsen symptoms and increase your risk of blood clots. To keep blood moving in these situations, do the following: Wear your compression stockings as instructed by your doctor. Do foot or leg exercises every half-hour to improve blood flow. Write the letters of the alphabet in the air with your toes. Or, do heel raises. Even a simple action such as wiggling your toes or changing positions can help. When sitting for long periods, such as during a plane flight, lift your heels up and down to work your leg muscles. 14
Exercise Exercise helps promote blood flow from your legs back toward your heart. Follow these tips to get the most benefit: Spend time each day doing exercises that work the leg muscles. Walking, swimming, and cycling are good choices. If you re new to exercise, start slowly. Build up to at least 30 minutes on most days. If you have a health problem that keeps you from being very active, ask your doctor for advice. He or she can recommend exercises that are right for you. Healthy Weight and Good Nutrition Being overweight puts extra pressure on your veins. To maintain a healthy weight, you may need to cut back on the number of calories you eat each day. Also, your doctor may ask you to limit your daily intake of salt (sodium). Too much salt causes your body to retain water. This can worsen symptoms, such as leg swelling and aching. Skin Care Keeping skin moist helps prevent dryness and itching. Proper skin care also makes ulcers less likely to form. Your doctor may advise you to apply special lotions to your skin daily. This works best right after you bathe or shower. 15
Also available in Spanish Working with Your Doctor With proper treatment and self-care, all vein problems can improve. Work with your doctor to learn more about your condition and the best treatments for your needs. Know that by taking care of your veins now, you can manage your symptoms and keep your veins healthy. Resources American Venous Forum www.veinforum.org Society for Vascular Surgery www.vascularweb.org Society of Interventional Radiology www.sirweb.org/patients TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit www.kramesurvey.com to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2015 The StayWell Company, LLC. www.kramesstore.com 800.333.3032 All rights reserved. Made in the USA. 12207 1504