Joan, a 45 year old cath lab scrub tech had been suffering with progressive leg swelling for at least 15 years. Although she did have a history of varicose veins in family, she did not have any signs of varicose veins, and had been told by a number of medical professionals that her excess weight was the main problem. Compression hose offered temporary relief for her. Exercise was difficult due to the heaviness, achiness and discomfort she had. Other symptoms included night time leg cramps and frequent nighttime urination. A detailed ultrasound evaluation confirmed severe bilateral great saphenous vein insufficiency and a subsequent radiofrequency endovenous ablation was performed on both legs 2 weeks apart with excellent results. She was seen for her 9 month follow-up recently and was elated with the relief of her heaviness and resolution of her night time urination.
Heart failure, kidney failure, excess salt intake and obesity are typically at the top the list of causes of swollen and achy legs. However, when one looks across the spectrum of patient ages, the most common and treatable cause of lower extremity swelling and achy legs is venous insufficiency, or venous reflux disease. For many years, venous insufficiency was typically referred to as “varicose vein disease” and if no varicose veins were visibly present the possibility of venous insufficiency was not further considered. The diagnosis of venous insufficiency as the potential cause for patients’ swollen and achy legs should not be dismissed based solely on the absence of visible varicose veins. To further clarify this point, let it be plainly stated that all patients with varicose veins have some degree of venous reflux disease or venous insufficiency, but not all patients with venous insufficiency have varicose veins.
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With approximately 40 million adults in the USA affected with treatable severe superficial venous insufficiency, many of these patients may have edema or swelling based on increased venous pressure in the legs without “obvious” external signs such as varicose veins, skin color changes or ulcers. So if you have swollen achy legs, heavy and fatigued legs which are worse at the end of the day, night time leg cramps, restless leg syndrome or nocturnal urination, a venous insufficiency evaluation by a dedicated vein specialist may provide you with answers. Venous insufficiency can and should be effectively evaluated and stratified by location and severity by specially trained vascular ultrasound technologists. The modern treatment of venous insufficiency with endovenous sealing using radiofrequency or LASER energy is a proven, effective, minimally invasive technique which continues to offer hope for millions of patients with symptomatic superficial venous insufficiency.
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