Peripheral Venous Disease
What is Peripheral Venous Disease?
Peripheral venous disease (PVD) is a circulatory disorder that occurs when veins that carry deoxygenated blood from the extremities back to the heart become damaged or blocked, causing various symptoms and complications.
Types of Peripheral Venous Disease
There are three common types of PVD:
- Chronic Venous Insufficiency (CVI): A condition where the vein valves in the legs do not work effectively, leading to poor blood return to the heart.
- Varicose Veins: These are enlarged, twisted veins visible under the skin, typically in the legs.
- Deep Vein Thrombosis (DVT): This is a blood clot that usually forms in the deep veins of the legs. Serious complications can occur if the clot breaks free and travels through the circulatory system.
Causes of Peripheral Venous Disease
Peripheral venous disease typically occurs as a result of:
- Valve dysfunction: The veins in the legs have one-way valves to prevent backflow of blood. When these valves are damaged or fail to close properly, blood can flow backward (venous reflux) and pool in the legs.
- Venous obstruction: Blood clots (thrombosis) in the veins, such as DVT can block blood flow and cause increased pressure in the veins.
- Weak vein walls: Chronic pressure or trauma can weaken the walls of veins, leading to dilation and reduced elasticity, which impairs proper blood flow.
Risk Factors for Peripheral Venous Disease
Risk factors for peripheral venous disease include:
- Prolonged standing or sitting
- Obesity
- Pregnancy
- Smoking
- Family history of venous disease
- History of deep vein thrombosis or vein injuries
- Chronic medical conditions such as diabetes or hypertension
Symptoms of Peripheral Venous Disease
Symptoms of peripheral venous disease include:
- Swelling in the legs or ankles (edema)
- Pain, aching, or heaviness in the legs
- Skin discoloration or changes around the affected vein
- Bulging or enlarged veins
- Itching or irritated skin over affected veins
- Ulcers or open skin sores, particularly near the ankles
Diagnosis of Peripheral Venous Disease
In general, diagnosis of peripheral venous disease may include the following:
- Physical Examination: Checking for swelling, skin changes, or varicose veins.
- Doppler Ultrasound: Evaluates blood flow and detects clots or valve dysfunction.
- Venography: Provides detailed imaging of the veins using contrast dye.
- Other Imaging: CT or MRI venography for more complex cases.
Treatment for Peripheral Venous Disease
Treatment options for peripheral venous disease include:
Lifestyle Modifications:
- Elevating legs to improve circulation.
- Wearing compression stockings to reduce swelling and pain.
- Exercise to promote blood flow and strengthen leg muscles.
- Weight management to reduce strain on veins.
- Avoiding standing or sitting for long periods.
Medications:
- Anticoagulants: Blood thinning medications to prevent or treat blood clots (e.g., warfarin, rivaroxaban).
- Anti-inflammatory drugs: Medications to reduce pain and swelling in thrombophlebitis (inflammation of the veins).
- Venoactive drugs: Medications to strengthen vein walls and improve symptoms.
Minimally Invasive Procedures:
- Sclerotherapy: Injects a solution to close varicose veins.
- Endovenous Laser or Radiofrequency Ablation: Uses heat to seal off damaged veins.
- Catheter-Based Thrombolysis: Dissolves clots in severe cases.
Surgical Options:
- Vein Stripping and Ligation: Removal of problematic/large varicose veins.
- Phlebectomy: Surgical removal of small varicose veins.
- Venous Bypass Surgery: Used for severe venous blockages and involves creating a bypass around blocked veins (rarely performed).
- Vena Cava Filter Placement: A filter inserted to prevent clots from traveling to the lungs in patients with DVT at high risk for pulmonary embolism.
