Strong Heart and Vascular Center

Division of Vascular Surgery

Chronic Venous Disease

Diagnosis

Blood returns to the heart via the veins. These are thin walled and have no pump, and blood has to move up against gravity. Normally the calves pump blood up when you move around, and valves prevent blood from falling back down. When either of these two factors are not working correctly (or, less commonly, blockage from an old clot is present), symptoms collectively known as chronic venous disease (CVD) occur. Such problems include swelling, weeping skin, skin discoloration, or even breakdown and ulcer formation. Such problems tend to occur low down near the inside ankle because of where the culprit veins usually are. At times, routine varicose veins alone can cause such problems if large enough. In addition, patients who are confined to a wheelchair or sleep sitting can have severe and intractable problems.

Today's Visit

We will perform ultrasound testing if data do not already exist. We will also discuss your medical history, the details of your situation, and options for treatment in better detail

Nonsurgical Treatment–What You Can Do

Gravity is the critical factor. In addition, it is the swelling (and increased skin pressure) caused by the valve problems that actually causes most of the problems. As such, treatment of these two events is the mainstay of therapy.

Gravity is "treated" by leg elevation. "Elevation" means that the legs must be at or above the level of the heart. Simply sitting, even with the legs propped up, does not help and, in fact, worsens the situation because the calf pump is not active. Standing still also does not help. A good strategy for maximizing elevation is to get into the habit of reading or watching TV from the couch, not a chair.

Edema is controlled by using prescription graduated compression stockings. These differ from the 'TEDS" many patients are used to in the hospital by being fitted individually to each patient and in having more compression down low, less up high. Knee-high stockings are usually fine. These will not treat established edema but can prevent it from forming as the day progresses, and hence must be fitted first thing in the morning when the legs are small, and then be donned first thing upon rising in the morning. Stockings are sometimes uncomfortable and each patient must make up his or her mind as to whether they are worth it, but there is no medical alternative or other therapy if stockings are not worn.

Finally, some patients have open wounds, the treatment of which is individualized. In such cases we frequently recommend a Profore dressing, which is a combination wound care and compressive wrap system that is applied in our office and changed weekly.

Surgery

At times, surgical therapy is appropriate. This usually consists of removing or dividing the culprit vessels (there is enough redundancy to allow this without problems in venous function and, indeed, if this is recommended the goal is to improve function), Each situation is different and we will discuss this option, if recommended, and all alternatives.