By Steve Spencer
25 to 30 million Americans suffer from venous reflux disease. This problem starts when the valves in the saphenous veins are damaged. The great saphenous vein is the longest vein in the body, running along the medial side of the leg from the foot to the top of the thigh. The small saphenous vein runs along the inner thigh.
“When we stand, gravity wants to pull the blood from our head to our feet,” said Charles Hunt II, MD, FACS, RVT of Alabama Vein & Restoration. “To prevent the blood from flowing the wrong direction and staying in our legs, we have 21 valves in the great saphenous vein and between nine and 12 in the small saphenous vein. This prevents reflux down the vein. With venous reflux disease, either through dilation or damage to the valves, blood begins flowing backwards in the saphenous veins causing congestion in the leg. Now we have excessive amounts of pressure within these veins and fluid. The pressure gets so great that the water leaks out of the veins into the tissue which causes your leg to swell. Also, red blood cells can leak out and then they deposit iron in your skin which results in discoloration.”
In addition to swelling and discoloration, other signs of the disease can include leg pain or heaviness; cramping; or restless leg syndrome.
The etiology of restless leg syndrome involves several factors including sleep apnea. However, in about one-third of venous reflux patients who also have restless leg, the restless leg gets better after treatment. “Many venous reflux sufferers are constantly moving their legs unconsciously because moving causes the calves to pump the blood out of your legs which alleviates the pain,” Hunt said.
If left untreated, venous reflux disease can cause a number of complications. It can negatively impact the lymphatic system by causing excessive fluid buildup in the tissues, which overwhelms the lymphatic system's ability to drain fluid, leading to potential damage to lymphatic vessels and ultimately resulting in lymphedema.
Venous reflux disease can also lead to destruction of the patient’s skin. “Through swelling, the skin stretches and then the arterial blood flow can't get to your skin and it starts to die,” Hunt said. “I've had patients with skin so hard that you can't introduce a needle into it. It’s like a piece of leather wrapped around wood.
“You can get venous ulcers on the bottom of your foot or on the tip of your toe, open lesions that won’t heal. It’s terribly painful. After we ablate the damaged veins that are causing the venous reflux, the wound will heal. In one case, I saw a man who had been treated for venous ulcers for 10 years, and following the ablation, the ulcers healed in a month.
“Venous reflux disease is also considered the underlying cause of varicose veins. We think of them as cosmetic, but while I can’t predict the odds of a blood clot, if you get a blood clot in a varicose vein, it's been my experience that 40 percent of the time, there is the risk that it can propagate or grow into the deep system. Now you go from superficial thrombophlebitis to deep vein thrombosis. And as a consequence, that clot can then mobilize and go to your lungs where it can block a lung artery resulting in a pulmonary embolus, which can be fatal.
“When we have a patient with superficial thrombophlebitis, we put them on blood thinners as some form of anticoagulant for a period of at least three to six months to make sure that resolves.”
Hunt treats conditions that result from venous reflux, like varicose veins, while performing the ablation procedure to treat venous reflux itself. He uses a 1320 nanometer wavelength laser, which requires less heat to close the vein, and has a 99 percent efficacy rate of closing the treated vein. The laser targets water in the vein wall, unlike older lasers that target blood, which makes the procedure more comfortable with minimal post-op bruising or swelling. It’s an outpatient procedure, using local anesthetic, and usually takes around 45 minutes. Patients usually go home the same day.
While minimally-invasive, ablative treatment is the ultimate solution, and the disease must be treated before it devolves into conditions like skin discoloration, skin hardening, and ulcers, there are a few steps people can take to help alleviate the symptoms: wear compression stockings to help blood flow; elevate your legs to reduce swelling; exercise regularly to improve circulation. Ultimately, early intervention is critical to prevent progression of the disease.