Venous Ablation for Lower Extremity Edema
Dr. Bruce Benedick and Dr. Melissa Kong have specialized training in the treatment of vein disorders. Vein problems present in a wide variety of ways. Sometimes they are simply cosmetic issues such as undesired small spider veins just under the surface of the skin, which can be treated with a localized injection to direct blood flow out of these abnormal blood vessels.
More commonly vein disease involves larger blood vessels well below the skin. Varicose veins are a common finding in America. This is caused by a localized enlargement of the vein often associated with abnormal backward blood flow which continues to stretch and enlarge these veins over the years. You can think of that as an aneurysm of the veins.
Many patients and unfortunately some doctors feel that this is only a cosmetic problem. We now more clearly understand that this abnormal back flow of blood in these abnormal veins also produce significant symptoms which can interfere with patient’s lifestyles. In particular our patients often tell us that they have experienced leg pain or aching, skin itching or rash, and often a sense of heaviness, or restless legs, which is worse after standing. This can progress to significant edema or swelling in the legs along with skin changes and even breakdown of the skin with development of skin ulcers which can be very difficult to heal. We have been surprised how many patients have had years of leg swelling and had no idea that this was related to disease of their leg veins.
This is often a progressive problem over many years. It not uncommonly runs in families. It can be worsened by pregnancy. Any occupation or activity that requires prolonged standing also significantly increases the problem.
We make the diagnosis by listening to your symptoms, examining your legs, and then when appropriate doing a painless ultrasound picture of your leg veins. This ultrasound picture can be done in our office.
Treatment can include low-sodium diet, leg elevation, or increased activity. Support stockings are often recommended. In some cases these lifestyle changes are not enough to improve our patient’s symptoms and additional treatment is required. In these cases one option is localized injection of material into the abnormal veins to close off the veins, which can be performed particularly if they are small veins. This is called sclerotherapy. Larger veins often require our specialized techniques of catheter thermal ablation or localized phlebectomy. All of these procedures can be performed in our office.
Catheter thermal ablation requires only local anesthetic anesthesia. We place an IV in the abnormal leg vein with the help of ultrasound pictures. A small wire is painlessly inserted through the IV. This wire is then heated and closes off the abnormal vein. This directs blood flow into the other healthy deep veins. This entire procedure takes less than one hour.
Recovery after these procedures is very quick. We encourage use of support stockings for at least one week after the procedure. Our patients are encouraged to continue to be active. A followup ultrasound picture is performed in a week. Patients often have some leg aching during this first week which quickly decreases. By one to two weeks, patients usually tell us that their legs feel significantly better.
As with other parts of our cardiology practice we see patient’s with a wide range of vein problems. Some patients vein problems are very straightforward and respond quickly to treatments. Other patient’s such as those with chronic nonhealing venous ulcers require a broad based approach to all other medical issues. We believe that as cardiologists we are well suited to take care of this wide range of needs rather than simply performing procedures and hoping that all the symptoms go away.