As hurricane Irma was bearing down on us in early September, we all had to quickly prepare and then make the difficult decision to either ride it out or evacuate. I know from my own experience as well as so many others I have spoken with that each approach had significant drawbacks. For those who stayed, there were days of sitting and watching the storm approach, and then inflict its wrath before moving up the state, leaving many in its path without power. This resulted in a complete disruption of daily activities and routines. Those who chose to evacuate faced long lines at the airport or bumper to bumper traffic for trips that took hours longer than usual.
As things started to get back to normal and patients returned to the office, I have been struck by how many patients, both new and established, had new or worsening lower extremity symptoms of pain or swelling during and after Hurricane Irma. For patients with venous disease, sitting or standing for prolonged periods of time is very difficult and can lead to significant pain and swelling. This was further worsened by the lack of electricity and air conditioning and the fact it was too hot to wear compression socks. The arduous travel and long periods of relative inactivity before and after the storm while trapped at home, in a car or in a hotel room was very difficult for patients who suffer from a medical condition known as venous insufficiency.
Venous insufficiency is a condition where the valves in the superficial venous system in the legs fail and over time leads to impaired blood return to the heart. Blood pools in the leg veins, especially when standing or sitting for prolonged periods of time as was required for so many people before and after the storm. This leads to abnormally high pressure in the veins or venous hypertension. It is this venous hypertension which leads to the many signs and symptoms of venous insufficiency.
Venous insufficiency is a very common and underdiagnosed condition affecting millions of Americans. It is estimated to be present in as much as 40% of the population and becomes more prevalent after age 50. Heredity is the major risk factor, as are a history of blood clots or DVT, obesity, and a standing or sedentary occupation. Female gender and prior pregnancies are also risk factors, though venous insufficiency afflicts many men as well.
Most people are aware of the most common sign of venous insufficiency which is varicose veins, but many people without varicose veins also have this condition. Venous insufficiency can manifest as a variety of signs and symptoms, many of which may not immediately come to mind when thinking about venous disease. Legs swelling as well as achy, heavy or tired legs at the end of the day are also common symptoms. In severe cases, the skin around the ankles can become discolored, thickened or even ulcerated over time.
As the pressure in the venous system builds throughout the day when patients are on their feet, symptoms progress and are often worse in the evening or at bedtime. This is when the lesser known symptoms of venous insufficiency such as restless legs, leg cramps and excessive urination become problematic and can rob a patient of a good night’s sleep. These symptoms can exist in the absence of venous disease but many with these symptoms if confirmed to have venous insufficiency by ultrasound respond very well to vein treatment. A trial of compression hose or socks can be the best predictor of which symptoms will respond to venous interventions.
Modern vein evaluation and intervention is much different than it was years ago. Prior to 2000, procedures such as vein stripping were very invasive, required general anesthesia, and had unacceptably high complication rates. For this reason, most patients with venous insufficiency were forced to suffer as there were no effective treatment options available other than compression hose and leg elevation.
At Vein Specialists in Fort Myers and Bonita Springs/ Naples, we offer comprehensive, modern vein evaluation and care. Dr. Joseph Magnant and I are board certified surgeons focused 100% on the management of venous disease. We start by performing a complete history and physical examination and then offer detailed ultrasound evaluations in our office which is the gold standard for evaluating venous disease. We are then able to formulate the best treatment plan for each individual patient.
In many cases the best treatment option for patients with venous insufficiency is something called endovenous ablation or vein closure. This can be accomplished with either LASER or radiofrequency (ClosureFAST™) catheters that allow us to heat and permanently seal the poorly functioning veins decreasing the venous pressure in the legs and significantly improving vein related symptoms. This procedure is minimally invasive and offered under local anesthesia in both our office locations with minimal discomfort.
The newest treatment option for vein closure is Venaseal™, which closes the vein using a medical adhesive rather than heat, and offers the advantage of requiring fewer injections. Other treatment options such as the removal of varicose veins through small incisions called microphlebectomy or injection sclerotherapy for bleeding veins and small varicose or spider veins are also available.
Intravascular ultrasound (IVUS) for the investigation of patients’ pelvic veins (iliac veins) is now available as well and may be appropriate for those patients who have had previous vein treatment but have not had the expected improvement, or have had recurrence of their vein symptoms years later. In patients who are found to have severe iliac vein blockages due to scar tissue or other obstruction, such as a previous blood clot or compression from the adjacent arteries, stent placement may provide significant symptom relief.
If you or a loved one has varicose veins or any of the other signs or symptoms of venous insufficiency, such as leg swelling, fatigue, achiness, cramps or restless legs syndrome, please consider visiting our website at Weknowveins.com for more information. Though the power is back on and hopefully life is getting back to normal, now is the time to be evaluated if you experienced any problems with your legs during or after the hurricane. Dr. Magnant and I see patients along with our highly trained nurse practitioners in both our Fort Myers and Bonita Springs/ Naples locations daily, so call for an appointment today.