Chronic Venous Insufficiency and Varicose Veins
Dr. Sae Hahm discusses the differences between chronic venous insufficiency, or CVI, and varicose veins.
Featured Speaker:
Previously, Dr. Hahm practiced at Princeton Surgical Associates, Dupage Medical Group and Caremount Medical as a general, vascular and endovascular surgeon. He has extensive knowledge in the evaluation and treatment of peripheral vascular disease, including carotid artery disease, abdominal aortic aneurysms, peripheral arterial disease, dialysis access surgery, venous disease, acute limb ischemia, limb salvage, varicose veins, and ultrasonography.
Additionally, his clinical practice focused on a full spectrum of open surgical and endovascular treatment, including angiography, atherectomy, angioplasty/stenting, mechanical thrombectomy, catheter-directed thrombolysis, endovenous ablation, and endovascular aneurysm repair.
During his career, he has authored various publications and abstract presentations.
Sae Hahm, MD
Sae J. Hahm, MD is a Board-certified general and vascular surgeon. Dr. Hahm joined The Vascular Experts in 2016. Dr. Hahm's recently joined Montefiore St. Luke's Cornwall's Medical Staff with a new office location at 21 Laurel Avenue in Cornwall, NY.Previously, Dr. Hahm practiced at Princeton Surgical Associates, Dupage Medical Group and Caremount Medical as a general, vascular and endovascular surgeon. He has extensive knowledge in the evaluation and treatment of peripheral vascular disease, including carotid artery disease, abdominal aortic aneurysms, peripheral arterial disease, dialysis access surgery, venous disease, acute limb ischemia, limb salvage, varicose veins, and ultrasonography.
Additionally, his clinical practice focused on a full spectrum of open surgical and endovascular treatment, including angiography, atherectomy, angioplasty/stenting, mechanical thrombectomy, catheter-directed thrombolysis, endovenous ablation, and endovascular aneurysm repair.
During his career, he has authored various publications and abstract presentations.
Transcription:
Chronic Venous Insufficiency and Varicose Veins
Caitlin Whyte: Varicose veins are veins that have become swollen enough to be seen on the legs affecting superficial veins, which lie closest to the skin. Joining us to talk about varicose veins and chronic venous insufficiency is Dr. Sae Hahm, a vascular surgeon with Montefiore St. Luke's Cornwall.
This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. Doctor, to start us off, what is the difference between chronic venous insufficiency and varicose veins?
Sae Hahm, MD: So chronic venous insufficiency is a clinical spectrum of a disease. Varicose vein is one part of chronic venous insufficiency. And there's many different degrees of severity of chronic venous insufficiency and varicose veins is just one part of that.
Chronic venous insufficiency is usually negative effects in the lower extremities from valve dysfunction or the veins not properly functioning. The veins allow blood to drain away from the legs. But if the valves break down over time, it can cause varicose veins to pop out in the legs. It can also lead to discoloration, pain, swelling as well as ulceration. So varicose veins is more of a mild form of chronic venous deficiency and the ulcers is the most severe form of chronic venous insufficiency.
Caitlin Whyte: And so what are some symptoms to keep an eye out for when it comes to these issues?
Sae Hahm, MD: So people with chronic venous insufficiency can present in many different ways. Simplest ways is just spider veins, the tiny little veins you see in the lower extremities, the ankles and the calves. Those usually don't cause pain. But if the varicose veins are noted, there are more like four or five millimeters. They're a little bit bigger and they bulge out in the calves. They can start causing pain, discoloration. You can get phlebitis, which means the superficial varicose veins develop irritation and superficial clots, which are usually benign, but it can also be a sign of deep vein blood clots, but it can also cause bleeding along the varicose veins if they've been there for a long time. And again, it can cause discoloration of the skin, the brownish discoloration that people can see, which can cause pain, ulceration, and it can cause significant itching. So if left untreated, those are the downsides. In addition, you can get cramping in the calves, fatigue when you're ambulating and can also lead to occasionally night cramps because of the valves being distended and causing pressure on the muscles over a long period of time.
Caitlin Whyte: And you mentioned in my first question, chronic venous ulcers. Can you tell us about those and how they're different from varicose veins and insufficiency?
Sae Hahm, MD: So venous ulcers is one spectrum of chronic venous insufficiency. It's one of the more severe form of chronic venous insufficiency and kind of later stage. And that is presented with ulcers around the ankles, but it can also be in the lower calf area and they can be very painful and it can be very difficult to heal. It's usually characterized by some swelling in the ankles and the calves and also with brownish discoloration. There can also be some reddish discoloration along the ankles, on the inside or outside. And it can also lead to infection if not treated appropriately. And that's how venous ulcers usually present.
Treatment is very similar to varicose veins. You treat the superficial veins that are affected, the valves that are damaged. We used to take those veins out, but nowadays we ablate those veins and shut them down. And occasionally, there's issues with the deep veins, which can have chronic scarring or clots that need to be treated with angioplasty or stenting, which is opening up the deep veins.
Caitlin Whyte: Now, you touched on this already, but what happens if these conditions are left untreated?
Sae Hahm, MD: So varicose veins, if they're symptomatic and they're left untreated, can progress and become more and more painful over time and can lead to phlebitis. Again, really painful varicose veins that turn red can lead to bleeding and again, ulceration, if left untreated over a long period of time.
In addition, same with venous ulcers, if not treated appropriately, those wounds, they can progress and lead to bad infections, hospitalizations. It's rare nowadays to have amputation from that. Thirty, forty, fifty years ago, that might've happened. But nowadays we have ways to treat venous ulcers more appropriately. But those are the negative effects of not treating them appropriately.
Caitlin Whyte: Well, let's dive into treatment in a bit more detail. What does it look like?
Sae Hahm, MD: Yeah. So for treatment of varicose veins and venous insufficiency and venous ulcers, the first treatment is really compression. And what we mean by that is compressing the vein with compression stockings that can be worn during the daytime. It also relieves the pressure in the veins and then relieves the pressure onto the skin and the wounds. So leg elevation is also important. People who are on their feet all day long, who require 12 hours up on their feet, it would be helpful for them to rest and elevate their legs periodically during the daytime to unload the pressure that occurs into the legs. That's the first line of treatment is the compression stockings.
The second line of treatment is looking at the superficial veins with ultrasound studies. So we have very specific ultrasounds that look at the valves in the superficial veins to see if they're weak. And when they're weak, it causes blood to pool on the legs and those veins can be shut down to decrease the symptoms and relieve the pain and help with the ulcer healing. That's the mainstay of treatment.
And sometimes we will treat the superficial veins with what we call phlebectomy, where we actually make little tiny little cuts under local anesthesia and remove those small veins. And we can inject them with foam, we call sclerotherapy, to shut down the small veins. For the more severe patients with venous ulcers, we do the same thing. But also we look at their deep veins, which is a lot of times or a percentage of them 30% to 40% might have blockages in the deep veins from chronic scarring or maybe a history of old clots that need to be opened up with the angioplasty or stenting that we mentioned before
Caitlin Whyte: And wrapping up here, are there any tips for prevention?
Sae Hahm, MD: Prevention is one thing. There's a hereditary component. It does run in the family in terms of varicose veins. So that's going to be hard to avoid. The other thing to help prevent that's hard to avoid is gravity. We're always up on our feet. We are upright creatures, so we are always affected by gravity. So if can try to combat gravity and that's by leg elevation, not standing too long for long periods of time. And also really wearing the compression stockings. For people who are predisposed or have some mild varicose veins that don't cause pain, wearing compression stockings regularly during the daytime can help prevent progression into symptoms and pain, phlebitis and ulcers, and then just periodically elevating your legs. That's the main way.
Other things are exercise is good. It helps pump the blood out of the legs. Obviously, obesity is a negative factor, so controlling that and diet are all good things to take care of as well, to help prevention and help progression of chronic venous insufficiency.
Caitlin Whyte: Well, thank you so much for your time and for this information, doctor. That was Dr. Sae Hahm, a vascular surgeon with Montefiore St. Luke's Cornwall. Learn more about us online at montefioreslc.org. If you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast for Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.
Chronic Venous Insufficiency and Varicose Veins
Caitlin Whyte: Varicose veins are veins that have become swollen enough to be seen on the legs affecting superficial veins, which lie closest to the skin. Joining us to talk about varicose veins and chronic venous insufficiency is Dr. Sae Hahm, a vascular surgeon with Montefiore St. Luke's Cornwall.
This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. Doctor, to start us off, what is the difference between chronic venous insufficiency and varicose veins?
Sae Hahm, MD: So chronic venous insufficiency is a clinical spectrum of a disease. Varicose vein is one part of chronic venous insufficiency. And there's many different degrees of severity of chronic venous insufficiency and varicose veins is just one part of that.
Chronic venous insufficiency is usually negative effects in the lower extremities from valve dysfunction or the veins not properly functioning. The veins allow blood to drain away from the legs. But if the valves break down over time, it can cause varicose veins to pop out in the legs. It can also lead to discoloration, pain, swelling as well as ulceration. So varicose veins is more of a mild form of chronic venous deficiency and the ulcers is the most severe form of chronic venous insufficiency.
Caitlin Whyte: And so what are some symptoms to keep an eye out for when it comes to these issues?
Sae Hahm, MD: So people with chronic venous insufficiency can present in many different ways. Simplest ways is just spider veins, the tiny little veins you see in the lower extremities, the ankles and the calves. Those usually don't cause pain. But if the varicose veins are noted, there are more like four or five millimeters. They're a little bit bigger and they bulge out in the calves. They can start causing pain, discoloration. You can get phlebitis, which means the superficial varicose veins develop irritation and superficial clots, which are usually benign, but it can also be a sign of deep vein blood clots, but it can also cause bleeding along the varicose veins if they've been there for a long time. And again, it can cause discoloration of the skin, the brownish discoloration that people can see, which can cause pain, ulceration, and it can cause significant itching. So if left untreated, those are the downsides. In addition, you can get cramping in the calves, fatigue when you're ambulating and can also lead to occasionally night cramps because of the valves being distended and causing pressure on the muscles over a long period of time.
Caitlin Whyte: And you mentioned in my first question, chronic venous ulcers. Can you tell us about those and how they're different from varicose veins and insufficiency?
Sae Hahm, MD: So venous ulcers is one spectrum of chronic venous insufficiency. It's one of the more severe form of chronic venous insufficiency and kind of later stage. And that is presented with ulcers around the ankles, but it can also be in the lower calf area and they can be very painful and it can be very difficult to heal. It's usually characterized by some swelling in the ankles and the calves and also with brownish discoloration. There can also be some reddish discoloration along the ankles, on the inside or outside. And it can also lead to infection if not treated appropriately. And that's how venous ulcers usually present.
Treatment is very similar to varicose veins. You treat the superficial veins that are affected, the valves that are damaged. We used to take those veins out, but nowadays we ablate those veins and shut them down. And occasionally, there's issues with the deep veins, which can have chronic scarring or clots that need to be treated with angioplasty or stenting, which is opening up the deep veins.
Caitlin Whyte: Now, you touched on this already, but what happens if these conditions are left untreated?
Sae Hahm, MD: So varicose veins, if they're symptomatic and they're left untreated, can progress and become more and more painful over time and can lead to phlebitis. Again, really painful varicose veins that turn red can lead to bleeding and again, ulceration, if left untreated over a long period of time.
In addition, same with venous ulcers, if not treated appropriately, those wounds, they can progress and lead to bad infections, hospitalizations. It's rare nowadays to have amputation from that. Thirty, forty, fifty years ago, that might've happened. But nowadays we have ways to treat venous ulcers more appropriately. But those are the negative effects of not treating them appropriately.
Caitlin Whyte: Well, let's dive into treatment in a bit more detail. What does it look like?
Sae Hahm, MD: Yeah. So for treatment of varicose veins and venous insufficiency and venous ulcers, the first treatment is really compression. And what we mean by that is compressing the vein with compression stockings that can be worn during the daytime. It also relieves the pressure in the veins and then relieves the pressure onto the skin and the wounds. So leg elevation is also important. People who are on their feet all day long, who require 12 hours up on their feet, it would be helpful for them to rest and elevate their legs periodically during the daytime to unload the pressure that occurs into the legs. That's the first line of treatment is the compression stockings.
The second line of treatment is looking at the superficial veins with ultrasound studies. So we have very specific ultrasounds that look at the valves in the superficial veins to see if they're weak. And when they're weak, it causes blood to pool on the legs and those veins can be shut down to decrease the symptoms and relieve the pain and help with the ulcer healing. That's the mainstay of treatment.
And sometimes we will treat the superficial veins with what we call phlebectomy, where we actually make little tiny little cuts under local anesthesia and remove those small veins. And we can inject them with foam, we call sclerotherapy, to shut down the small veins. For the more severe patients with venous ulcers, we do the same thing. But also we look at their deep veins, which is a lot of times or a percentage of them 30% to 40% might have blockages in the deep veins from chronic scarring or maybe a history of old clots that need to be opened up with the angioplasty or stenting that we mentioned before
Caitlin Whyte: And wrapping up here, are there any tips for prevention?
Sae Hahm, MD: Prevention is one thing. There's a hereditary component. It does run in the family in terms of varicose veins. So that's going to be hard to avoid. The other thing to help prevent that's hard to avoid is gravity. We're always up on our feet. We are upright creatures, so we are always affected by gravity. So if can try to combat gravity and that's by leg elevation, not standing too long for long periods of time. And also really wearing the compression stockings. For people who are predisposed or have some mild varicose veins that don't cause pain, wearing compression stockings regularly during the daytime can help prevent progression into symptoms and pain, phlebitis and ulcers, and then just periodically elevating your legs. That's the main way.
Other things are exercise is good. It helps pump the blood out of the legs. Obviously, obesity is a negative factor, so controlling that and diet are all good things to take care of as well, to help prevention and help progression of chronic venous insufficiency.
Caitlin Whyte: Well, thank you so much for your time and for this information, doctor. That was Dr. Sae Hahm, a vascular surgeon with Montefiore St. Luke's Cornwall. Learn more about us online at montefioreslc.org. If you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast for Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.