Venous Disease and Varicose Veins

Your circulatory system relies on a vast network of vessels called arteries and veins to transport blood throughout the body.

Every time your heart beats, it pumps blood that is full of life-sustaining oxygen. Your arteries carry this blood away from your heart to all of your organs, then your veins complete the circuit by bringing the blood (at this point depleted of oxygen) back to your heart.

Your veins contain tiny flaps, called valves, which have the ability to open and close. An open valve allows blood to flow freely through your vein, while a closed valve ensures blood can only flow in one direction (toward your heart).

If the valves inside of your veins become diseased or damaged, they may not close completely. This means blood won’t flow properly — it will either leak backward, or flow in both directions. Over time, improper blood flow can lead to a variety of problems including blood clots, swollen veins, leg pain, skin discoloration and open sores.

While vein disease can occur anywhere in the body, it often affects the legs. This is because your blood and venous valves must fight against gravity in order to return blood from your legs and feet back up to your heart. Damaged valves lead to distended veins, which in turn exert negative effects on the soft tissues and skin of your legs. Vein valve damage can be caused by many different factors, such as trauma, surgery, pregnancy or blood clots. They can also be hereditary or be caused by working in a profession that requires you to be on your feet a lot.

Scripps physicians treat the full range of venous disorders, ranging from common varicose veins to life-threatening blood clots, using a combination of medical treatment and vascular surgery. We have a dedicated team of physicians and vascular surgeons who have extensive experience managing the following conditions. Several of these conditions are treated at our Comprehensive Vein Treatment Program, located at Scripps Clinic Carmel Valley and Scripps Clinic John R. Anderson Medical Pavilion.

• Varicose veins are swollen, discolored and knotty-looking veins in the legs that are easily seen through the skin.
• Spider veins are dilated capillaries on the skin, resembling spider legs.
• Venous ulcers, also known as stasis ulcers, are shallow but slow-healing wounds that form on the skin, usually on either side of the leg between the calf and ankle.
• Chronic venous insufficiency occurs when the valves in your leg veins don’t close properly, allowing blood to collect or “pool” in the veins. This causes leg swelling and achiness, and puts you at a greater risk of developing varicose veins and venous ulcers.
• Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in one of the so-called “deep veins” that are found inside your muscles. While a deep vein clot can form anywhere in your body, including your arms and chest, it often occurs in the legs. DVT can become life-threatening if the clot travels through your body, becomes stuck in a blood vessel and blocks blood flow to your lungs (a condition known as pulmonary embolism).
• Iliofemoral DVT is a type of deep vein thrombosis that occurs specifically in the iliac and femoral veins, which run from the lower leg up into the lower abdomen. Patients with iliofemoral DVT are often at greater risk for long-term medical problems than people who have DVT in another part of their body, and they often require more aggressive treatment.
• May-Thurner syndrome (MTS), also known as iliac vein compression syndrome, occurs when the right iliac artery presses the left iliac vein against the lower spine. Because the vein is compressed, blood cannot adequately flow through it and often pools in the left leg. Someone with a compressed iliac vein is at much greater risk of developing DVT than the average population.
• Pelvic congestion syndrome, also known as pelvic venous incompetence, is a painful condition that causes varicose veins to form near a woman’s ovaries or uterus.
• Arteriovenous malformations (AVMs) occur when an abnormal connection between veins and arteries that’s present at birth causes them to tangle, disrupting proper blood circulation. While AVMs can form anywhere in the body, they pose the most risk if located in critical structures, such as the brain or spinal cord.

Most forms of vein disease cause the following symptoms, often present in the lower legs:

• Bulging, twisted veins that are easily visible through the skin
• Swollen legs and ankles
• Pain, aching or a heavy feeling in the legs
• Skin discoloration and itching in the legs
• Open sores on the lower legs, often between the calf and ankle
• Chronic pain in a woman’s pelvic region (in cases of pelvic congestion syndrome)

Because some venous disorders, such as deep vein thrombosis (DVT), can be life-threatening, people with the following symptoms should call their doctor or 911 immediately:

• Sudden swelling, pain or cramping in one leg
• Sudden shortness of breath
• Chest pain that gets worse when you take a deep breath
• Rapid pulse
• Coughing up blood
• Sudden dizziness, light-headedness or fainting

Risk factors for venous disease include:

• Age (50 or older)
• Family history of vascular disease
• Female gender
• Obesity/overweight
• Extended periods of immobility
• Among women, pregnancy and use of medications such as birth control or hormone replacement therapy can increase risk of varicose veins and DVT

Scripps doctors can accurately diagnose vein problems using one or more of the following tests:

• Vascular ultrasound (also called a duplex ultrasound), a non-invasive imaging procedure that allows doctors to evaluate how blood is flowing through a vein or artery. In addition to detecting narrowed arteries, vascular ultrasound can also identify blood clots that have formed in veins.
• Computed tomography (CT) scan, a painless, noninvasive way to see inside the body using X-ray imaging.
• Magnetic resonance imaging (MRI) scan, a procedure that uses a powerful magnet, radio waves and computer technology to produce pictures without using ionizing radiation
• Conventional venography, a procedure to evaluate the venous system
• Angioplasty or stent to open narrowed or blocked veins

Scripps offers the full range of medical and surgical treatments for venous disorders, including the latest minimally invasive, laser- and catheter-based procedures. Venous treatments typically work in one of two ways — either by collapsing and permanently closing a problem vein, or by breaking up or removing a blood clot before it can cause further harm.

The procedures listed below are typically used to address vein problems that do not involve blood clots, including varicose veins, venous ulcers and chronic venous insufficiency.

• Endovenous radiofrequency ablation, also known as catheter-assisted heat ablation, uses heat delivered by a catheter to destroy a problematic vein. 
• Endovenous laser therapy, sometimes called laser surgery, uses laser technology to seal the vein shut.
• Medical adhesive, like VenaSeal, may also be used to seal a vein shut.
• Injection-compression sclerotherapy uses a chemical solution, injected directly into the vein, to help the vein walls stick together and seal shut.
• Ultrasound-guided sclerotherapy is an advanced form of injection-compression sclerotherapy. During the procedure, ultrasound technology helps detect problem veins that are not visible on the skin’s surface. Once these veins are located, they can be injected with a chemical solution that permanently closes them.
• Ambulatory phlebectomy is a minimally invasive surgical procedure that allows physicians to remove varicose veins that are close to the surface of the skin. The veins are removed from the leg through tiny incisions made in the skin. The incisions are small enough to heal on their own (no stitches required).
• Coil embolization, also known as endovascular coiling or endovascular embolization, is a minimally invasive procedure that allows surgeons to close off a faulty vein. During the procedure, a catheter is used to place a tiny metal coil into the vein, which prevents blood from flowing into it. Coil embolization is often used to treat chronic venous insufficiency and pelvic congestion syndrome.

The final three procedures described below are used to treat conditions (such as DVT) that require destroying or removing a blood clot. These procedures may be used alone or in combination with one another:

• Thrombolysis, also known as thrombolytic therapy, is used to dissolve a blood clot with medication injected directly into the vein.
• Thrombectomy is a minimally invasive surgical procedure that uses catheters to either break up or remove a blood clot from a vein.
• Venous angioplasty and stenting is an endovascular procedure used to treat a vein that has been narrowed or blocked. During the procedure, a balloon-tipped catheter is used to both inflate the vein and to insert a tiny tube called a stent that will keep the vein propped open.

Scripps Health offers comprehensive endovascular and vascular treatment in San Diego at the following locations:

• Prebys Cardiovascular Institute
• Scripps Green Hospital
• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital San Diego

Scripps Health offers comprehensive vein treatment in San Diego at the following locations:

• Scripps Clinic Carmel Valley
• Scripps Clinic John R. Anderson V Medical Pavilion