How is Chronic Vein Disease Diagnosed?
The main way to diagnose CVI is by a physical examination at your doctor’s office. He or she will ask about your medical history and your symptoms, and examine your legs for signs of varicose veins, skin changes, swelling, and tenderness. Your doctor may also use a hand-held device called continuous wave Doppler< that uses reflected sound waves to allow the doctor to listen to blood flow in your legs.
The most common test for leg vein disease is a venous ultrasound test, which uses sound waves (like those used to view the fetus during pregnancy) to produce images of the veins in your legs and the blood flow through them. These images allow doctors to identify blockages or malfunctioning vein valves, and can precisely locate vein problems if you are considering undergoing a procedure to treat vein disease.
Your doctor may also recommend a test called plethysmography, which measures the volume of blood flowing in and out of your leg as your veins fill and empty. This can be done using an air cuff around your leg, or a light and light sensor to measure changes in blood volume.
How is Chronic Vein Disease treated?
If your vein disease is mild or in the early stages, behavioral and lifestyle changes may be enough to control your symptoms. As with all forms of heart and blood vessel disease, you need to get your risk factors under control. For women with CVI, managing high blood pressure, controlling your weight, and staying physically active (at least 30 minutes of exercise a day, 5 or more days a week) are particularly important to ease the pressure on your leg veins.
The first choice treatment for chronic vein disease is leg compression, which involves wearing knee-length graduated compression stockings as much as possible during the day. Some women may need waist-high stockings if their vein disease is higher in the leg. Compression stockings can reduce your leg symptoms, prevent swelling,7 and reduce the risk of blood clots. Prescription stockings work better than over-the-counter stockings sold at drug stores. You should not wear compression stockings if you have peripheral artery disease or nerve problems in the legs, as it can make these conditions worse.
Proper skin care is also extremely important because CVI increases your chances of developing painful skin sores and rashes. Keep the skin on your legs well-moisturized and talk to your doctor if you notice a rash, itchy or scaly skin, or open wounds. He or she can prescribe steroid creams to help relieve skin rashes and instruct you on the use of medication and bandages to help wounds heal and prevent ulcers from spreading.
Some other tips on controlling your CVI symptoms:
- Avoid prolonged standing or sitting
- Elevate your feet above your thighs when sitting, and above your heart when lying down – do this at least 3 times a day
- Avoid wearing clothes that are tight around your waist, thighs, or legs (you should wear compression stockings as prescribed, however)
- Talk to your doctor about an exercise plan to strengthen calf muscles
If basic treatment alone is not able to control your symptoms, or if you have more severe CVI, non-healing ulcers, or disease in your deep leg veins, further treatment may be necessary to relieve symptoms and prevent dangerous complications such as blood clots. Which treatment is best for you depends on which veins are affected, how severe the disease is, and your general health.
There are many procedures to treat vein disease. In most cases, injections or surgery are used to seal off and close the affected vein, or to remove it altogether. Over time, your body will turn the closed vein into scar tissue, and other nearby veins will take over the blood flow. A doctor who specializes in treating vascular disease can help you decide which procedure is right for you.
Vein Injection (Sclerotherapy) : the most common treatment for varicose veins. A liquid or foam is injected into the vein, causing the vein walls to stick together and seal shut. More than one treatment may be needed to close the vein. This treatment can be done in a doctor’s office and does not require anesthesia.
Ligation and Stripping : the standard treatment for many women with CVI, especially those who have developed leg ulcers or disease in the deep veins of the leg. Small incisions are made in your leg, and the affected veins are tied off and then removed. This surgery is done in an operating room and requires local or general anesthesia.
Vein Bypass Surgery : A surgical procedure in which a vein from elsewhere in the body is used to create an alternate route for blood to flow around the blocked vein.
Vein Ablation with Laser or Radiofrequency : less-invasive treatment for problems in the large or deep veins. A long, thin tube called a catheter is inserted into your veins. Once there it sends out radiofrequency or laser energy that shrinks and seals the vein. This type of procedure is done under anesthesia in an operating room, but has a faster recovery time than vein surgery.
Vein Stenting : for women who have narrowed veins in the pelvis that prevent blood from leaving the legs, opening the vein can relieve CVI symptoms. A long, thin tube called a catheter is inserted into the vein, a balloon is inflated in the vein to open it up, and a wire mesh tube called a stent is left in place to prop the vein open.
Valve Reconstruction : used in women who have malformed or damaged vein valves that are contributing to CVI. Valve reconstructions can be done surgically or through a long, thin tube called a catheter. This is a rare procedure and is only done is selected patients.
Can I prevent chronic vein disease?
While it is not always possible to prevent vein disease, there are some things you can do to lower your chances of developing serious vein problems:
- Maintain a healthy weight; lose weight if you are overweight
- Control your blood pressure
- Get regular exercise
- If you smoke, get the help you need to quit
- Avoid sitting or standing still for long periods