Chronic Venous Insufficiency
Chronic Venous Insufficiency (CVI) is the most common disease in North America among adults. This little known fact means that 1 in 8 Americans will suffer from symptoms related to diseased veins in their lifetime. If one was to add up diseases 2 through 5 (heart disease, cancer, stroke and lung disease) it wouldn’t add up to CVI.
The problem in this disease lies in the incompetency of the valves that are present in veins. Normally, there is one-way flow from a person’s feet back to their heart against gravity. When these one way valves malfunction, the blood tends to pool near the feet, where you would expect gravity to draw it.
This pooling affects the venous blood pressure. Normally, the pressure in the venous system is 5-15 mm HG. With bad venous pooling, or REFLUX, the pressure can rise to 50 mm Hg, a gain of 500%. This results in all the symptoms that a vascular specialist commonly sees.
- Varicose Veins
- Pain ( this is very common but not normal)
- Pelvic Congestion (especially around the time of a woman’s menses)
Aesthetically, CVI or venous reflux can lead to visible, ugly reticular veins and spider telangiectasia (spider veins) a common problem that causes many people to shy away from bathing suits, shorts or skirts.
I prefer a combination of laser therapy (elos from Syneron) and pilodocanol (Asclera) to treat spiders and reticular veins up to 4 mm. This method also carries an 85% success rate in my hands, the other 15% of stubborn veins succumbing to a second treatment. Patients are kept in ace bandages or compression stockings for 48 hr after the procedure and have minimal if any complications.
I treat the underlying valve problem, or reflux, with the “Closure” procedure (www.vnus.com). This is technically known as Radiofrequency (RF) Ablation therapy and using a tiny catheter, seals-or closes- the vein from the inside. The vein is accessed through a small 2 mm incision and instantly clears up the reflux in 85% of patients. The complication rate for this procedure approaches 0%. The other 15% have other sources of valvular disease besides the vein being treated and may require other interventions.
I have found this procedure to be extremely successful in over 2500 patients and move to the cosmetic side of the equation after dealing with the underlying pathology.