Varicose veins can be a symptom of chronic venous insufficiency (CVI), a progressive medical condition that affects the ability of veins in the legs to return blood to the heart. If left untreated, CVI can lead to discomfort, swelling, skin changes, and even ulcers. Fortunately, advancements in medical technology offer a highly effective and minimally invasive treatment called venous ablation.
Chronic Venous Insufficiency - A Cause of Swollen and Painful Legs
Featuring:
Chanaka Wickramasinghe, MD
Board Certified in Internal Medicine and Cardiology, Chanaka Wickramasinghe, MD, received his medical degree at King’s College London GKT School of Medical Education. He subsequently moved to the United States for further training and completed his residency at University of Texas Southwestern Medical Center in Dallas. During his residency, he excelled in both academic and leadership roles and was chosen to serve as Chief Resident for the medicine residency program for an additional year.
He completed a cardiovascular fellowship at UCLA Medical Center and was again recognized for his leadership and academic excellence and served as Chief Fellow during his final year.
Dr. Wickramasinghe knew at an early age he wanted to pursue medicine as a career. “I was always good at science and was very intrigued with how the body worked,” states Dr. Wickramasinghe. While in his residency program, Dr. Wickramasinghe was exposed to numerous subspecialties, but it was cardiology that best aligned with his personality. “I was drawn by the interaction of pathophysiology, pharmacology and functional anatomy in cardiology and the evidenced-based nature of the specialty.”
Dr. Wickramasinghe strongly believes that patients should be involved in making decisions about their health care, and that it is his role is to provide them with as much information as possible to make the best informed decision. He states, “Shared decision making and good patient-physician relationship is vital to treatment compliance and good long term outcomes.”
In addition to being board certified in Internal Medicine and Cardiology, Dr. Wickramasinghe is also board certified in Echocardiography and Nuclear Cardiology. He has special interests in treating patients with congestive heart failure, cardio-oncology (cardio-toxic effects of chemotherapy) as well as being involved in advanced imaging for structural interventions such as Transcatheter aortic valve replacement (TAVR) and MitraClip.
Transcription:
Caitlin Whyte (Host): This is Living Well with Eisenhower Health, healthcare as it should be. I'm Caitlin Whyte. With me is Dr. Chanaka Wickramasinghe, a cardiologist from Eisenhower Health. Join us as we talk about chronic venous insufficiency, a condition that affects the return of blood from the legs to the heart, resulting in symptoms like discomfort and swelling. Well, Doctor, start us off today. Just what is chronic venous insufficiency?
Dr. Chanaka Wickramasinghe: So, chronic venous insufficiency is actually a very common condition. It's relatively underdiagnosed. And for that reason, not many people are aware of it. The blood vessels in your body, there are two types of blood vessels. There's blood vessels that carry blood away from your heart to the rest of your body, and then blood vessels that bring blood back to your heart.
So, the blood vessels that bring blood back to your heart are called the venous system. And in your legs, you have the venous system that's supposed to bring everything back up towards your heart. Now, over time, what happens? Those veins start leaking. And when they start leaking, you get chronic venous sufficiency.
Host: And you mentioned that this is a common condition, but just how common is it?
Dr. Chanaka Wickramasinghe: So, you know, the estimates are about a hundred million people in the USA have some form of venous insufficiency. Venous insufficiency, again, just means leaking veins in your leg. So, instead of the blood coming up all the way, some of the blood or fluid drains back down your leg. And it's very common. There are several stages of symptoms and several stages of the condition, but the estimates are roughly a hundred million people have some stage of chronic venous insufficiency.
Host: Just what causes it? How does this happen?
Dr. Chanaka Wickramasinghe: There are multiple risk factors for venous insufficiency. One of the most common things is just age and use. As we get older and we are on our feet and using our legs more, the veins start deteriorating over time. The venous system has little valves all along the way of the vein to prevent backflow of blood. And over time with use, those valves start leaking. So, instead of a on-way valve carrying blood upwards, some of the blood starts spilling downwards.
Some of the other well-known risk factors are family history. So, there's a bit of a genetic basis for it. So when I see patients who have really advanced severe venous insufficiency, it is not uncommon to hear that their parents had it or their siblings had it.
Tobacco is a big risk factor. Just like most health conditions, tobacco damages blood vessels. You damage your blood vessels, you damage your valves, you start leaking blood towards your leg. Some of the other risk factors we see are occupational-related, so occupations where people are on their feet a lot. So, nurses, doctors, barbers, flight attendants, anybody who is on their feet a lot and carrying a lot of weight, puts pressure on your legs.
In women due to hormonal changes and also with pregnancy, especially multiple pregnancies, you can get more venous insufficiency. And that's because when you're pregnant, your womb enlarges, puts pressure on your pelvic veins, which backs up pressure into your leg veins, and causes the valves to get damaged.
So, those are the most common risk factors: age, female sex, multiple pregnancies, family history, tobacco use and occupations or lifestyles where you have prolonged standing.
Host: All right. Well, now that we know some causes, what are some common symptoms?
Dr. Chanaka Wickramasinghe: So, the most common symptoms I hear about when somebody walks through my office is the first thing they notice is swelling. The legs start swelling, especially towards the end of the day, or with prolonged standing or sitting. When you go to bed at night and you're laying flat, your legs are at the level of the heart, so you eliminate gravity and it helps drain your legs.
When you get up in the morning and you go about your day, whether you're seated in office or you are up and walking, your legs now have to fight gravity to bring the blood flow up. So, you start noticing by the evening, your legs look more swollen. As that progresses, people start noticing fatigue, heaviness in the legs, pain in the legs, and then in more advanced stages, people start noticing discoloration of the skin, the skin starts getting brown. And in severe cases, people start getting wounds or ulcers that don't heal very well.
Host: So if we are experiencing that leg pain or swelling, how do we then go about getting this diagnosed?
Dr. Chanaka Wickramasinghe: Very good question. So, I think for anybody who's noticed pain, swelling, fatigue, or heaviness in the legs, it's a good idea to think of could this be chronic venous insufficiency? The first step is to speak to your healthcare provider, whether it be a primary care physician or if you already see a cardiologist or a vascular specialist, to let them know about your concerns, because there's testing. We do simple office testing to diagnose this conditions.
So in my clinic, the first test we do when we have a patient with suspicion for venous insufficiency is a simple ultrasound scan, which is a non-invasive scan of your legs, which shows us the blood vessels. We can measure the flow up the leg and the flow down the leg to see how much is going upwards and how much is leaking downwards.
Host: So, what can patients do to improve their symptoms if they're experiencing them?
Dr. Chanaka Wickramasinghe: Excellent. So, there are a couple of simple things that we recommend all patients, regardless of symptoms even. You know, I think for most of us as we get older, especially if you are on your feet a lot. A couple of things are very helpful to try and prevent or prolong the occurrence of symptoms. So, elevation of your legs. Just removing gravity and helping your legs drain is one of the simplest things you can do. So when you are seated at home on the sofa, kick your legs up onto the sofa. If you have a recliner, even better.
The second thing I tell patients, if you are flying, if you're driving long distances, or if you're going to be standing on your feet a lot, use compression stockings, because that makes a big difference by allowing external pressure on the veins so that the veins drain upwards more easily. So, elevation and compression are the two first things we recommend all patients do when they start getting symptoms.
Host: And how about treatment options? Can you tell us about those?
Dr. Chanaka Wickramasinghe: So, there are fortunately some treatments out there for this condition, depending on the severity of the condition and what we see on the ultrasound scan. Fortunately, the procedures we do for venous insufficiency are very minimally invasive, as in they're all done in the office setting. And the basis of the treatment is you want to try and close off those leaking veins and essentially divert the blood flow to healthier veins in your legs. So, they go up. So, there's three procedures that are commonly used. One is called a radiofrequency ablation. One is where we use chemical method of applying a chemical adhesive glue to close the vein. And the third is where we use a sclerosing fluid to close the vein. The common goal is close the leaking vein, get the healthier veins to go up. And as I mentioned previously, these procedures are very minimally invasive, done in the office, very minimal recovery time and very low risk procedures.
Host: Now, you said this treatment is not invasive, but just how successful is it if we do end up getting it?
Dr. Chanaka Wickramasinghe: So in the ideal patient who has evidence of venous insufficiency who is compliant with the supportive management aspects of elevation and compression, closing the leaking veins with one of those three techniques, the three procedures I mentioned, you can get about 95% success in improving the leaking veins.
Host: Well, thank you so much, Doctor, for joining us today. For more information, please visit insights.eisenhowerhealth.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Caitlin Whyte, and this is Living Well with Eisenhower Health, healthcare as it should be. Thanks for listening.