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Author: Dr. Irwin B Simon

Dr. Irwin B. Simon is a General Surgeon who has resided in Las Vegas since 1993. He is a graduate of Hahnemann University School of Medicine in Philadelphia, PA. After medical school, Dr. Simon trained as a General Surgeon at Mount Sinai Medical Center in Cleveland, Ohio. He then completed a Fellowship in advanced Therapeutic Endoscopy and Advanced Laparoscopic Surgery, also at Mount Sinai Medical Center.
Deep Vein Thrombosis

Deep Vein Thrombosis

Deep vein thrombosis (DVT) happens when a thrombus, or blood clot, occurs in one or more of the deep veins in your body. While a DVT can form in other areas, they most commonly occur in the legs.

Though DVT typically causes leg pain or swelling, instances may also occur without symptoms, making them much harder to detect. DVT usually develops as the result of medical conditions that affect the way the blood clots or as a result of sitting for extended periods of time.

Left untreated, a DVT blood clot can break off and travel to the lungs, causing a pulmonary embolism, which is life-threatening. It can also lead to complications in the legs, such as post-thrombotic syndrome and chronic venous insufficiency.

Fortunately, a DVT is preventable, and it is treatable if discovered early.

Description and Symptoms of Deep Vein Thrombosis

 

medical diagram of deep vein thrombosis in leg area.

The circulatory system contains both arteries and veins. Arteries carry oxygen-rich blood from the heart to other tissues in the body, while veins return the oxygen-depleted blood back to the heart.

There are two types of veins:

  • Superficial veins, which lie just below the surface of the skin.
  • Deep veins, which are located deeper,  within the muscles.

In most cases, a DVT only forms in one leg or one arm, rather than both. The symptoms of a DVT may include:

  • Swelling of the affected leg or arm, which may occur suddenly.
  • Pain or tenderness in the affected leg or arm, which may only occur when walking or standing.
  • Warmth in the affected area.
  • Red or discolored skin in the affected area.Though this should NOT be confused with signs of a superficial venous thrombosis.
  • Enlarged veins near the skin’s surface in the affected area.

Pulmonary embolism. Human silhouette with highlighted circulator

If the DVT dislodges or breaks off and traveled to the lungs, causing a pulmonary embolism, the symptoms may include:

  • Sudden shortness of breath or rapid breathing.
  • Sharp chest pain that is worsened by coughing or movement.
  • Back pain.
  • Cough, with or without bloody sputum or phlegm.
  • Excessive sweating.
  • Rapid heartbeat.
  • Dizziness or fainting.

In some cases, patients are unaware of a DVT until the clot moves to their lungs. Because of this, it’s important to seek medical attention if you notice any symptoms of a DVT or pulmonary embolism, to prevent serious complications.

Difference Between DVT and Superficial Venous Thrombosis

A superficial venous thrombosis, also called superficial thrombophlebitis or phlebitis, is a blood clot that develops in a superficial vein. These types of blood clots are unlikely to travel to the lungs or cause life-threatening complications, unless they move from the superficial vein to the deep venous system. This is a rare occurence.

Risk Factors for DVT

Risk Factors for DVT

A DVT can occur in anyone, regardless of age, race, activity level, or prior medical conditions. Certain factors can increase the chance of developing a DVT, however, especially if several occur at the same time.

Here are some factors that increase the likelihood of developing a DVT:

  • Injury to a vein, which may be caused by fractures, significant muscle injury, or major surgery of the pelvis, abdomen, hip, or legs.
  • Slow blood flow, which may be caused by confinement to bed, limited movement, sitting for long periods of time, or paralysis.
  • Excess estrogen, which may be caused by birth control pills, hormone replacement therapy, or pregnancy and post-pregnancy.

Certain chronic medical conditions can increase the risk as well, such as:

  • Heart disease.
  • Lung disease.
  • Cancer.
  • Cancer treatment.
  • Inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease.

Other risk factors may include:

  • Previous instances of DVT or pulmonary embolism.
  • Family history of DVT and pulmonary embolism.
  • Obesity.
  • Age.
  • A catheter within a central vein.
  • Genetic clotting disorders.

Complications of DVT

doctor examining a lung radiography x ray.

The most serious complication of DVT is when the clot breaks off and travels to the lungs, resulting in a pulmonary embolism. Like DVT, a small pulmonary embolism that’s treated quickly and effectively can end in a full recovery, but there is a risk of lung damage or death. A massive DVT can be fatal within minutes.

DVT can also result in long-term complications from the damage that occurs to the valves in the veins, which is called post-thrombotic syndrome. Patients with post-thrombotic syndrome develop symptoms like pain, aching, and itching in the legs, skin discoloration, swelling, and in severe cases, scaling or ulceration in the affected area. These symptoms can be severe enough to cause disability.

Chronic venous insufficiency is another long-term complication of DVT. This is a condition in which the venous walls or valves in the vein are no longer working effectively, making it difficult for the blood to return to the heart from the legs. This causes blood to collect in the veins, known as stasis. The symptoms of chronic venous insufficiency include swelling, aching, and weakness in the legs, leathery skin, flaking or itching in the skin, venous stasis ulcers, and varicose veins.

Despite a widely held belief, a DVT does not cause a heart attack or stroke. These are caused by the blockage of an artery, known as arterial thrombosis. These types of clots can be serious, since they can obstruct the flow of blood to major organs, such as the heart or brain, leading to heart attack or stroke.

In addition, a DVT or pulmonary embolism can become chronic, with roughly 30 percent of patients at risk for recurrence.

DVT Prevention

doctor examining a lung radiography x ray.

Like most medical conditions, DVT and pulmonary embolisms are much easier to prevent than treat.

Here are a few preventative measures to lower your risk of DVT:

  • Stay mobile, especially after bed confinement, such as after an injury, illness, or surgery. Be as mobile as possible, directed by your doctor.
  • Wear loose-fitting clothing. More important, do not wear tight clothing that restricts the blood flow in your leg veins.
  • When sitting for long periods of time, try to walk every hour, certainly every two or three hours.  Exercise your legs by raising and lowering your heels and toes or by contracting and releasing the muscles of your legs.
  • Use graduated compression stockings, as directed by your doctor.
  • Talk to your doctor about medications to prevent DVT.
  • Avoid a sedentary lifestyle.
  • Maintain a healthy weight.

If you’re concerned about developing DVT or a pulmonary embolism, speak with your doctor about specific preventative measures that are appropriate for your current health conditions and family history.

Diagnosing DVT

Diagnosing DVT

If DVT is suspected, a doctor will perform a thorough exam and review your medical history to look for risk factors. Several tests are administered to diagnose a DVT, such as:

  • Duplex venous ultrasound: This is a common diagnostic test for DVT. A duplex venous ultrasound shows blood flow in the veins and detects any existing blood clots. The ultrasound technician will apply pressure to the leg or arm, and if the vein doesn’t compress, it could indicate the presence of a blood clot.
  • Contrast venography: This test uses an x-ray to show the deep veins by using contrast material injected in the vein. Abnormalities, blood clots, or blockages are then visible. This testing may be used if the duplex venous ultrasound results are inconclusive.
  • Magnetic Resonance Imaging (MRI) or Magnetic Resonance Venography (MRV): An MRI shows organs and structures within the body, and an MRV shows the veins. These two types of imaging can provide a more comprehensive picture than an x-ray.
  • Computed Tomography (CT) scan: This is a type of x-ray that shows the structures within the body. A CT scan may be used to detect a DVT in the abdomen or pelvis, as well as to detect a pulmonary embolism.

If a genetic component is suspected, blood tests may be needed, such as the D-dimer blood test, which measures a substance in the blood that’s released when the clot breaks up. This is important if:

  • You have a history of blood clots that don’t have an apparent cause.
  • You have a blood clot in an unusual location, such as the veins in the liver, kidney, brain, or intestines.
  • You have a family medical history of blood clots or clotting disorders.

Treating DVT

Woman with varicose veins applying compression bandage

Patients with DVT may need hospitalization, though less severe cases may be treated on an outpatient basis. The goals of treatment are as follows:

  • Stopping the clot from getting bigger.
  • Preventing the clot from breaking off and traveling to the lungs, leading to a pulmonary embolism.
  • Reducing the risk of developing recurrent clots.
  • Minimizing the risk of developing serious complications.

Common treatments include:

Anticoagulants

These are “blood thinning” medications that affect the blood’s ability to clot. Though these medications are called “blood thinners,” they don’t actually thin the blood. Instead, they reduce the ability of the blood to clot. Anticoagulants can stop clots from getting bigger or moving to other areas of the body as well.

Anticoagulants don’t dissolve or destroy a clot, but the body has the natural ability to resorb it. In some cases, a clot will be dissolved by the body, but won’t disappear entirely.

The most common injectable anticoagulants are:

  • Unfractionated heparin injected intravenously (into the vein).
  • Low-molecular-weight heparin injected subcutaneously (under the skin).
  • Fondaparinux injected subcutaneously.

The most common oral anticoagulants are:

  • Warfarin.
  • Dabigatran.
  • Rivaroxaban.
  • Apixaban.
  • Edoxaban.

Anticoagulants may only be prescribed for three to six months, but may be prescribed for longer periods in patients with:

  • Recurrent DVT or pulmonary embolisms.
  • Presence of other chronic conditions, such as cancer, that may increase the risk of a blood clot.

Different anticoagulants have different side effects, but the most common are bleeding, such as nosebleeds or bleeding gums, and bruising. In these cases, it’s best to consult a doctor to avoid any serious complications.

Thrombolytics

Thrombolytics are medications that actually act to dissolve blood clots to improve blood flow and prevent damage to the tissues. While these are effective medications for dissolving clots and preventing complications, they do carry a higher risk of excessive bleeding, so they are only used in severe cases.

Inferior Vena Cava Filter

If anticoagulants aren’t appropriate for treating DVT, a filter may be inserted within the inferior vena cava, a large vein that carries deoxygenated blood from the lower body to the heart, to remove or trap a clot before it reaches the lungs.

Thrombectomy

In severe cases, a thrombectomy may be used to remove the clot and prevent it from causing serious complications. This is a surgical procedure that involves an incision in a vein to remove the clot, then repairing the venous wall to restore blood flow. In some cases, a balloon-like device is used within the vein to prevent collapse.

If the clot is near the lungs, an embolectomy may be appropriate. This is a surgical procedure that involves an incision or a catheter inserted in the affected vein to remove the clot.

These procedures are usually recommended in emergency situations where other clinical interventions are not effective.

Compression Stockings

Graduated compression stockings, also called medical compression stockings, may be used to prevent or reduce leg swelling. Swelling often occurs as a result of damaged valves within the leg veins. Most compression stockings are worn to just below the knee and are tight throughout the ankle, gradually loosening as they reach the knee. This provides consistent, gentle pressure on the leg. However, thigh high or pantyhose high compression stockings are often more appropriate and effective .

Preparing for Your Appointment

success smart medical doctor working with operating room

A DVT is considered a medical emergency, so it’s vital to seek medical attention immediately if you suspect one. If there’s enough time, however, there are a few things you can gather to help your diagnosis and treatment.

Make a list of:

  • Your symptoms, including any that seem unrelated but that may have appeared suddenly, and when your symptoms began.
  • Family history of blood-clotting disorders.
  • Your medical history, including hospitalizations, surgeries, traumas, or chronic illnesses.
  • All medications you take, including vitamins or supplements, and their dosages.
  • Questions you may want to ask.

Some questions you may want to ask include:

  • What’s the most likely cause of the symptoms?
  • What diagnostic testing can be expected?
  • What type of treatment is available?
  • What alternative treatments are available?
  • Are there any restrictions on physical activity or travel?
  • What’s the best way to manage DVT and existing medical conditions?
  • Are there any recommended printed materials or resources for DVT?

You should also expect questions from your doctor, such as:

  • Have you been inactive lately, such as lying down or sitting for long periods?
  • Are your symptoms constant, or intermittent?
  • Are your symptoms more or less severe at different times, such as early morning or after exercising?
  • Does anything improve your symptoms?
  • Does anything worsen your symptoms?

The more information you can provide to your doctor, the more effective and prompt your diagnosis and treatment can be.

Varicose Veins and DVT

varicose veins on a female legs

According to a study in the Journal of the American Medical Association (JAMA), there’s a significant association between varicose veins and DVT, with less significant associations with pulmonary embolisms and peripheral artery disease.

The finding of this retrospective study of over 400,000 people is that varicose veins are a common condition, but they can be associated with more serious health risks, such as DVT and other vascular conditions. Varicose veins (Superficial veins) do not typically cause DVT.  Rather it is the other way around. Further research is needed to determine if there is a causal relationship between varicose veins and DVT, as well as if there’s a common cause of the two, but it could indicate the importance of early evaluation of varicose vein disease.

Varicose veins are veins that become twisted and enlarged, most commonly in the legs, which can result from weak or damaged valves. Healthy veins return deoxygenated blood back to your heart, working against gravity to travel through tiny valves that, when working properly, stop the blood from flowing backward. If these valves are weak or damaged, blood can pool in the vein, causing it to stretch or twist.

In addition to being uncomfortable and unsightly, varicose veins can be painful and carry a risk of chronic swelling and venous stasis ulcers, which are open wounds that are difficult to heal. Varicose veins may also progress to a condition known as stasis dermatitis, which is a red rash on the skin in the affected area that may become shiny, hairless, and discolored. Venous stasis dermatitis is  alate complication of superficial venous reflux and varicose veins, often progressing to painful open sores (leg ulcers).

In most cases, varicose veins only worsen with time, so early treatment is recommended to prevent complications like pain, cramping, itching, swelling, and fatigue.

Visit Vegas Valley Vein

Though many patients with varicose veins have a problem localized to the leg, there are hereditary and medical factors that can cause or worsen varicose veins and their associated complications, such as DVT.

If you are suffering from varicose veins, it’s important to seek evaluation and treatment from a vein specialist, such as Dr. Simon at Vegas Valley Vein. After evaluating your medical history and the severity of your condition, we’ll recommend the appropriate testing and vein treatment for your needs to help you relieve the suffering of varicose veins. Contact us today to schedule your consultation!

pressure on the veins

Varicose veins and spider veins are unsightly and uncomfortable conditions that affect many people, and, in the case of varicose veins, they can lead to serious complications. To help alleviate the symptoms of varicose veins, you may consider laser or surgical procedures that are designed to relieve pressure on the veins and promote better circulation.

Fortunately, there are many different types of vein treatments to choose from, and they can all be performed on-site at a vein treatment clinic. The recovery time is minimal as well, so you’re able to return to your normal routine in no time.

If you’re considering vein treatment, take a look at this guide to vein conditions, vein treatments and what to expect before, during and after your surgery.

What Causes Varicose Veins and Spider Veins?

Though often regarded as a cosmetic issue, varicose veins and spider veins are symptoms of underlying vein problems. Left undiagnosed and untreated, varicose and spider veins can develop into other problems.

circulatory system: heart, cross-section artery and vein, normal

Both varicose veins and spider veins are symptomatic of an issue with your circulation. In healthy individuals, arteries transport oxygenated blood from your heart to your muscles, bones and tissues. When this oxygen is depleted, veins move the deoxygenated blood back to the heart, and it is then pumped back into the lungs for more oxygen. This process is challenging to your body, especially in the lower extremities, because your body needs to work against gravity to keep blood flowing properly.

Your veins also have a series of tiny back-pressure or flap valves that only open in one direction, ensuring that when normal, the blood flows  back to your heart. If these valves are damaged by disease or injury, blood can flow backwards (reflux) and pool in the lower extremities, creating pressure and swelling in the veins. As this pressure builds, more valves can become damaged, along with the walls of your veins. With prolonged reflux, veins become weaker and more fragile, leading to a condition known as Chronic Venous Insufficiency, or CVI.

Varicose veins and spider veins occur when these issues affect veins close to the surface of the skin. With varicose veins, the veins protrude and may appear large and twisted, whereas spider veins look like a web of red, purple or blue lines.

What Are the Symptoms of Vein Disease?

Varicose veins and spider veins are visible symptoms of CVI, but they’re not the only symptoms. Many individuals with vein disease experience heaviness and weakness in the legs, or even sharp leg cramps that occur at night. As expected, restless leg syndrome is frequently connected to superficial venous reflux disease.

Close-up of leg with varicose veins

If left untreated, the swelling of leg veins can lead to many skin conditions, such as:

  • Skin tightness.
  • Skin itchiness.
  • Discoloration in the legs and ankles.
  • Fragile skin.
  • Slow wound healing.
  • Cellulitis, in extreme cases,
  • Bleeding.
  • Phlebitis.
  • Deep Vein Thrombosis (DVT).

With prompt and accurate diagnosis, these symptoms can be relieved or prevented.

Conditions Related to Vein Disease

Unfortunately, the veins in your legs aren’t the only ones that may be affected by vein problems. Here are some other conditions related to vein disease:

  • Hemorrhoids: Hemorrhoids are actually varicose veins that are found in or around the anus. These may cause itching, pain or bleeding, and are usually caused by bowel pressure. Fortunately, this condition can be easily treated with lifestyle changes. Surgery is rarely necessary.
  • Leg ulcers: As venous disease advances, it may lead to painful ulcers that form on the skin near the varicose veins, mostly near the ankles. When the venous circulation is compromised, blood pools in the veins, also known as venous stasis, and increases pressure within affected veins. This causes skin breakage and ulcer formation, which require immediate medical attention.
  • Sudden leg swelling: If you experience considerable swelling in your leg from enlarged deep veins, it’s important to see a doctor immediately. This may indicate thrombophlebitis, a painful condition in which a blood clot blocks a vein. On occasion, superficial venous thrombophlebitis may lead to a deep vein thrombosis.

Who’s at Risk for Vein Disease?

Vein disease usually affects individuals over the age of 50, but it may develop earlier for some. Certain risk factors for CVI are not always within our control, but they may be reduced through smart lifestyle choices.

There is a genetic component to vein disease as well, so if you have a family history of varicose and spider veins, you’re more likely to develop the condition. A history of blood clots, leg trauma or injury, or certain types of cancers may be all be factors as well, along with being a woman who is pregnant, has been pregnant, or is peri- or post-menopausal.

doctor showing varicose veins from an elderly woman

While these factors may be out of your control, you can still take preventative actions to lower your risk of vein disease. Avoid sitting or standing for long periods of time, maintain a healthy weight, stay active and avoid smoking or excessive drinking to reduce your risk of vein disease.

Self-Care for Vein Conditions

The best way to treat varicose and spider veins is by doing what you can to stay healthy and prevent them from forming. Here are some self-care tips to prevent or treat mild varicose veins:

  • Avoiding standing or sitting for long periods of time. If it’s not possible to avoid prolonged sitting or standing, move your legs as much as possible to keep the blood circulating.
  • Wear compression stockings to help your legs transport blood to the heart and prevent pooling of blood in the legs.
  • Elevate your feet above your heart as much as possible.
  • Engage in exercises that improve circulation in the legs, such as walking, jogging, running or swimming. This also helps you maintain a healthy weight.
  • Try to eat healthier and lose weight if you’re overweight.

When Is the Best Time for Vein Treatment?

Vein disease affects about 25 million Americans. It can range from discomfort and heaviness in the legs with no visible signs, to spider veins, varicose veins, skin discoloration, skin thickening or skin ulcers. Generally, vein conditions start out small and worsen over time, but the future effects may be preventable with early treatment.

What Types of Vein Treatments Are Available?

Venous conditions can be treated with many different procedures, most of which are minimally invasive.

doctor and an assistant in operating room for surgical clinic

Here are the leading vein treatments:

  • Venefit (VNUS Closure) Procedure: Radiofrequency Ablation (RFA): This is a non-surgical alternative for treating varicose veins. As an alternative to surgical stripping of the greater or lesser saphenous vein (and others),  an RF probe is passed through an IV access. During this procedure, radiofrequency energy is used to heat and contract the collagen within the vein walls, causing the vein to collapse and seal. After it closes, blood is rerouted to healthy veins naturally. RFA is the gold standard against which other procedures are measured for comparison.
  • Endoscopic Venous Laser Therapy. (EVLT). Many patients hear the word “laser” and envision its use as the most up to date or the least invasive or the least painful of procedures. This procedure is still commonly utilized.  However over the years EVLT has been demonstrated to be less safe, less effective and more painful than Radiofrequency Ablation (RFA).
  • Varithena Microfoam Chemical Ablation: This is a foam created by mixing  polidocanol and oxygen. Although it is injected, it should not be confused with sclerotherapy.   This injectable foam is used to treat certain refluxing veins and especially large and twisted varicose veins caused by problems with the greater saphenous vein and other related veins.
  • Sclerotherapy: Sclerotherapy is performed with an injected chemical irritant that goes directly into the spider vein, shrinking it in size and relieving the associated discomfort.
  • Asclera: Asclera is the most common sclerosing agent that is injected into the vein and damages the endothelium, or the cells lining the inside of the blood vessels. This causes platelets to attach to the lining of the vessels, causing the blood vessel to clot. Over time, the clotted vein will be replaced with scar tissue.
  • Ambulatory Phlebectomy: Also known as stab phlebectomy. This procedure uses tiny punctures or incisions to remove the varicose veins.
  • Vein Gogh Ohmic Therapy: This is a procedure that uses a tiny needle probe to deliver Radiofrequency and  thermocoagulate and eliminate tiny blood vessels. It’s typically used to treat fine telangiectasias, broken capillaries, angiomas and spider veins that have shown resistance to other treatments. It’s also suitable for sensitive areas and areas of veins too small for injection of sclerosing agents such as Asclera.
  • VenaSeal: This is a non-tumescent, non-thermal, non-sclerosant procedure that uses a proprietary medical adhesive delivered endovenously to seal off the vein.

Your vein doctor will work with you to determine the best vein treatment option(s) for your specific vein issues, medical history and desired results.

Vein Treatment Consultation

Before any decisions about your treatment are made, you’ll need to meet with the doctor for a consultation. This appointment will include a thorough discussion about your medical history, family history, vein conditions, vein symptoms and any previous injury or illness that may have resulted in vein damage. The consultation may also include an examination of your legs to check for swelling, and an ultrasound to examine the blood flow in your legs and identify any vein conditions.

doctor  in operating room for surgical venous vascular surgery

The initial consultation is an excellent time to address any questions or concerns you may have. Be sure that you fully understand your treatment options and the risks and benefits involved, and that you feel completely comfortable with your treatment team. Bring a list of your current and past medications to your appointment, and be sure to disclose any medications you’re taking to be sure that they don’t impact your treatment.

You may also discuss your insurance coverage with the staff to see if your specific diagnosis and treatment are covered by your insurance and what, if anything you’ll be responsible for financially.

After vein ultrasound and mapping is completed, the physician can then complete your consultation.  Specific treatment recommendations are then made. You will receive specific instructions for the time leading up to the day of the procedure as well as for immediately following the procedure. Be sure to follow these instructions carefully, and be sure you bring everything you need with you to the appointment.

The Day of the Procedure

On the day of the procedure, you’re free to eat or take any prescribed medications, unless you’ve been advised otherwise during your consultation. It’s advisable to wear loose-fitting clothing. At the conclusion of any procedure, you will have your leg firmly wrapped with compression bandages or you may be asked to wear your compression stockings.

Depending on the vein treatment will be made comfortable with a local anesthetic. Rarely is any sedative medication necessary.  ANy sedative utilized is typically taken by the patient in pill form. If any sedative is taken, the patient will b e advised to arrange a ride home. Otherwise, typically, patients are comfortable and drive themselves home or back to work after a procedure.

doctor and an assistant in operating room for surgical  clinic

At the start of any procedure,  the treated leg will be sterilized and prepared for the planned procedure. During ablation and phlebectomy procedures, a local anesthetic will be injected along the course of the targeted vein or veins, then treated. With sclerotherapy procedures, the injections are placed directly into the targeted veins. Most vein procedures are completed in under an hour, depending on the size and number of veins treated and the treatment type.

Immediately after any procedure is completed, the treated area may be bandaged and/ or you’ll have a compression stocking placed on your leg. Compression stockings apply external pressure on your leg veins to reduce swelling and prevent blood from pooling in the veins, which helps with venous blood circulation. Compression stockings may also alleviate some of the discomfort following your vein treatment.

You’ll also have a printed copy of aftercare instructions and any prescribed medications to take home with you.

After the Procedure

After the doctor bandages your legs, you’re free to return home or to work. As mentioned, please arrange a ride if your treatment involves sedation.

Once you’re home, you’ll need to wear your compression wrap or stockings for the following two days without removing them. After that, you’re free to remove the stockings and bandages, and with most procedures, you’re able to get your legs wet. Your doctor will advise you if you need to avoid getting the treated areas wet, and for how long.

Most vein procedures are minimally invasive and carry few risks of complications, but it’s still best to take precautions to aid in recovery and minimize risks. Generally, you’re able to resume daily activities as soon as you return home, but you should avoid strenuous activity, heavy lifting or excessive stress for a few days, and wait at least one day to shower. It’s also important to avoid soaking in pools, hot tubs or bathtubs to minimize the risk of infection.

There’s usually only mild discomfort following vein treatments, but if you’re experiencing pain, the doctor may recommend ibuprofen (Motrin) or acetaminophen (Tylenol). If the pain continues or worsens, call your doctor, and make an appointment with your doctor for a checkup.

Side Effects and Complications

Most patients experience very minimal bruising, swelling, tightness and skin discoloration near the treated veins in the days following these procedures. These symptoms are not a cause for alarm. They typically may persist for  a month but on occasion may persist for 3 months or more before compoletely subsiding. Numbness in the skin near treated veins may occur, but will usually dissipate over the same time.

Vein treatment side effects

During your recovery, you’ll have follow-up appointments with your doctor within the first month and once more after six months. Most often by 3 to 6 months after completion of all recommended treatments, any side effects should have dissipated, and you should be seeing the results of your vein treatment.

Visit Vegas Valley Vein Institute

In the past, there were few viable options for treating varicose veins and spider veins, and what was available was highly invasive. Surgery was debilitating, requiring prolonged periods of lost work.  Fortunately, recent advancements in the treatment of varicose veins, spider veins and other vascular conditions have made it possible to remove unsightly and uncomfortable veins with effective, minimally invasive procedures that provide permanent results. Many health insurance providers cover vein treatments as well, making them more accessible than ever.

If you’re considering vein treatment for your varicose veins, spider veins or other vascular conditions, Vegas Valley Vein Institute would love to help. We combine the best of traditional methods and state-of-the-art, non-surgical treatments to provide you with the ideal vein treatment customized to your needs and to give you results that last. Contact us today to learn more about our vein treatments!

restless leg syndrome

Restless Leg Syndrome

Also known as Willis-Ekbom Disease, Restless Leg Syndrome (RLS) is a condition that’s characterized by unpleasant and uncomfortable sensations in the legs and an uncontrollable urge to move them. Restless leg syndrome has many possible causes, including venous disease, and effective treatment revolves around managing the symptoms to improve quality of life. So, if you’re suffering from RLS and are diagnosed with an underlying venous disease, there is hope for treatment and relief of symptoms.

While the severity may differ between affected individuals, most patients report symptoms that occur in the late afternoon to evening hours, with the worst effects occurring at night when the patient is resting. This can also occur when the patient is inactive or sitting for long periods of time, such as on a road trip.

Because the condition worsens during the night, RLS can cause sleep disturbances and difficulty returning to sleep after arousal. In many cases, moving the legs or walking can temporarily relieve the discomfort, but the sensations return once the movement stops.

RLS is classified as a sleep disorder, due to the symptoms being triggered by resting and worsening in the evening, and a movement disorder, since patients are forced to move in an effort to relieve discomfort. Though these classifications apply, RLS best fits the category of neurological-sensory disorder, since the symptoms and underlying condition are caused by the brain.

Businesswoman sleeping with head on hand at work

RLS can also be found in a group of disorders that contribute to exhaustion and daytime drowsiness, which can have an impact on concentration, job performance, mood, personal relationships and overall wellbeing. Because of the sleep disruption, patients affected by RLS report an inability to concentrate, poor memory and difficulty performing day-to-day tasks. Left untreated, moderate to severe cases of RLS can lead to a 20 percent decrease in productivity, as well as anxiety and depression.

At this time, it’s estimated that roughly 10 percent of the U.S. population suffers from RLS symptoms. Though it can affect both men and women, it’s more common in women. The most severe cases typically occur in middle-aged individuals, though it can start at any age, and the symptoms tend recur more frequently and at greater severity with age.

Among patients with RLS, over 80 percent also experience periodic limb movement of sleep (PLMS). This is characterized by involuntary twitching and jerking movement of the legs and arms during sleep, which can occur every few seconds throughout the night. PLMS is a separate condition, however, so those with PLMS don’t necessarily have RLS.

Symptoms of Restless Legs Syndrome

As the name suggests, RLS is characterized by an irresistible and uncontrollable urge to move, which often includes unpleasant sensations in the legs that are dissimilar to sensations that are commonly experienced by healthy individuals. The sensation is difficult to describe accurately, but many patients report pulling, aching, throbbing, crawling, itching or creeping feelings. These sensations are typically felt in the legs, but some patients experience them in the arms, head or chest. It’s also possible to have RLS symptoms on only one side of the body or alternating between sides, and most patients report symptoms on both sides.

When the symptoms become too severe, patients will move constantly to relieve the sensations, which can include rapid leg movement, tossing and turning, fidgeting or pacing the floor.

woman awake bed night insomnia

One symptom that’s nearly universal across patients is that the severity of symptoms increases significantly at night, followed by a brief, symptom-free window in the early hours of the morning. This helps some patients get more restful sleep, but it’s rarely enough to counteract the effects of prolonged sleep disturbances. In some cases, sleep deprivation can worsen the symptoms, creating a vicious cycle.

Though it’s a chronic condition with no known cure, RLS is highly variable. The symptoms can vary in severity and frequency between patients, or even from one day to the next. Unfortunately, just a few occurrences of severe RLS symptoms can be enough to disrupt the sleep schedule and affect alertness and function during the day. For patients who experience more frequent and severe symptoms, the impaired function can be detrimental.

Remission can occur with RLS as well, with spontaneous periods of symptom relief that can last weeks or months, but this is more common in the early stages. RLS is progressive, so the symptoms will become worse over time.

Furthermore, if RLS is connected to another condition, the onset tends to be rapid and extreme. For those without a related condition contributing to RLS, the symptoms tend to progress slowly, sometimes resulting in years between episodes.

Causes of Restless Leg Syndrome

Researchers have yet to find a true cause of RLS, but it has been established that there’s a genetic component. This can be seen in families with RLS patients who experienced an onset of symptoms prior to age 40. Evidence also indicates that low levels of iron can contribute to RLS as well, but more research is needed.

brain neurons synapse, anatomy body, head profile, disease

A vast amount of research indicates that RLS symptoms arise from dysfunction in an area of the brain that controls movement, the basal ganglia, and the neurotransmitter dopamine, which is needed for purposeful movement of muscle. When these neural pathways are disrupted, it can cause involuntary movement. Parkinson’s disease, a disorder of the basal ganglia dopamine pathways, also increases the risk of developing RLS.

Other evidence suggests that RLS may be related to the following conditions:

  • Iron deficiency.
  • End-stage renal disease.
  • Hemodialysis.
  • Neuropathy.

The use of certain substances, such as nicotine, caffeine and alcohol, may also be related to RLS. Though they’re not considered related, the use of certain medications, such as antiemetic, antipsychotic, antidepressant and antihistamine medications, are believed to increase the severity of RLS symptoms.

Pregnancy is connected to RLS as well, though the symptoms typically resolve in the weeks following delivery. Sleep disorders and sleep deprivation are also believed to trigger or worsen existing RLS symptoms.

Restless Leg Syndrome Diagnosis

There’s no diagnostic test for RLS, so patients must be evaluated by a doctor to decide if they’re suffering from RLS or another condition.

Clinical diagnosis of RLS includes the following criteria:

  • A powerful, uncontrollable urge to move the legs that may be associated with uncomfortable or unpleasant sensations.
  • The urge to move is triggered or worsened by long periods of inactivity.
  • The urge to move is temporarily relieved by movement.
  • The urge to move is worse in the evening and at night.
  • The previous symptoms can’t be attributed to other conditions.

leg_pain_diagnosis

In diagnosing RLS, the doctor will use the description of symptoms, as well as the specific triggers and methods of alleviating discomfort and the time periods of symptoms over the course of the day. In addition to these specific diagnostic criteria, the doctor will also review the medical and family history, current or past medications, a physical exam and in some cases, a neurological exam.

The doctor will also evaluate the duration, frequency and severity of symptoms, the time it takes to fall asleep, the need for movement to relieve symptoms, sleep disturbances, daytime drowsiness and ability to perform daily tasks.

Certain laboratory tests can eliminate other possible conditions that cause these symptoms, such as iron-deficient anemia, pregnancy or kidney failure. Blood tests are typically used to identify these conditions. Sleep studies may also be used to determine other possible causes of sleep disturbances and sleep deprivation, which may affect the management of RLS symptoms. During these sleep studies, any noticeable limb movement may support the RLS diagnosis, but that can be seen in healthy individuals as well, so it’s not clinically significant on its own.

Diagnosing children with RLS is particularly challenging, since children are unable to articulate their symptoms and experiences in the same way as adults, especially when it comes to length and frequency of symptoms. Because of this, RLS symptoms in children are often attributed to other conditions.

Restless Legs Syndrome Treatment

There’s no cure for RLS, but treatment revolves around the management of symptoms. Movement is believed to alleviate the uncomfortable sensations, and cases of RLS with identifiable underlying conditions can be controlled by treating the cause.

Increasing iron intake can be helpful for some patients, especially if the RLS is caused by an iron deficiency, but it’s not appropriate for all cases. Other medications may help, but there’s no specific drug designed to treat RLS specifically. Because of this, patients need to try different treatment protocols to find medications that work for them.

Medical equipment : stethoscope ampoules and syringe on white ba

Other RLS treatment options include:

  • Lifestyle changes: In some cases, patients find relief through specific lifestyle changes, such as eliminating or reducing the use of nicotine, alcohol and caffeine, maintaining a normal sleep cycle, massaging the legs, using a heating pad or adopting an exercise routine. Stretching and aerobic workouts may provide relief for some patients. The Food and Drug Administration (FDA) also approved a few medical devices that can relieve the symptoms of mild to moderate RLS.
  • Iron supplements: Ferritin and transferrin saturation are the two blood tests that measure the iron levels in the blood. If these tests come back low or on the lower end of the normal range, iron supplements are tested as a possible treatment. These are available over the counter and have minimal side effects, such as digestive upset. Supplemental iron isn’t absorbed as readily as naturally occurring iron, so it can cause constipation or hard stools in some patients. In some cases, iron supplementation has no effect on iron levels, so iron given intravenously can be used to relieve symptoms and restore healthy iron levels.
  • Anti-seizure medication: Anti-seizure medications, such as enacarbil and gabapentin, have been approved by the FDA for the treatment of moderate to severe RLS. For many patients, these medications are effective and carry little risk of worsening symptoms. Other anti-seizure medications may be used to decrease the sensory disturbances and nerve pain associated with RLS. The side effects for these medications include fatigue, dizziness and drowsiness.
  • Dopaminergic medications: Dopaminergic medications increase the activity of dopamine-related processes in the brain, so they’re usually indicated as treatment for Parkinson’s disease. When taken at night, dopaminergic medications are effective for relieving the symptoms of RLS. These drugs are usually well tolerated, but their side effects include dizziness and nausea.

Unfortunately, the long-term use of dopaminergic medications can cause a worsening of symptoms in many patients. Over time, sufferers may find that their symptoms appear earlier in the evening, eventually becoming an around-the-clock issue. The dose may become ineffective over time as well, and the symptoms may increase in intensity or begin to affect other areas of the body. In some cases, dopaminergic medications may lead to obsessive or compulsive behaviors, which usually disappear once the medication is stopped.

  • Opioids: Opioid drugs include methadone, oxycodone, hydrocodone and methadone, and can be used to treat the severe symptoms of RLS in patients who haven’t responded well to other treatment options. These drugs have some serious side effects, however, such as dizziness, nausea, chronic constipation and a high risk of addiction, but low doses are usually prescribed to treat RLS.
  • Benzodiazepines: Benzodiazepines help with sleep, which is one of the biggest concerns with RLS. Though they can promote a restful sleep, benzodiazepines may also lead to daytime fatigue and drowsiness, as well as decreased focus and concentration. These drugs are typically used to treat muscle spasms, anxiety and insomnia. Because these drugs may also cause long-term sleep problems, they are reserved as a last resort for managing RLS.

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One of the biggest challenges for RLS patients is dealing with chronic discomfort, so finding support and coping strategies are necessary to prevent depression, anxiety and similar conditions.

  • Talking to family, friends and other sufferers helps a patient develop a support system to turn to when symptoms are severe or persistent. This also helps patients cope in social situations, without having to explain the urge to walk, stand or pace to relieve symptoms.
  • Keeping a diary can be helpful for both doctors and patients, since it provides a means for tracking symptom frequency, severity and onset, as well as medical interventions that did or did not provide relief.
  • RLS support groups bring patients together to share insights, frustrations and challenges among other RLS sufferers and family members. Like support groups for other chronic conditions, RLS support groups not only help patients combat the depression related to the condition, but also gives them emotional support to supplement medical treatment.

Restless Legs Syndrome Prognosis

RLS isn’t a life-threatening condition, but it is chronic and has no current cure. Many therapies and interventions are used to minimize symptoms, control the negative effects and promote normal sleep cycles, however. In most patients, this condition is progressive and the symptoms worsen with age, though this effect is often accelerated in cases of RLS that’s secondary to another medical condition.

close up of doctor and woman meeting at hospital

Having RLS is not a risk factor for other neurological diseases, despite the similarities in the pathology. Some RLS patients also experience remissions, or periods of time without symptoms, though the symptoms usually reappear at another time.

If RLS symptoms are mild and don’t cause significant disruptions to sleep cycles or day-to-day tasks and activities, it doesn’t require treatment.

Ongoing Restless Legs Syndrome Research

With so many patients affected by RLS symptoms, many researchers are seeking a better understanding of causes and contributors to the condition, as well as potential treatment options.

Despite the unknowns, it’s believed that disruptions in the brain’s signaling pathways are a significant factor in the disease, particularly with dopamine signals in the basal ganglia. This is further supported by the ability of dopamine agents to treat RLS and other movement disorders, but more research is needed to find the connection between long-term use of dopamine agents and the prevalence of impulse-control disorders.

restless leg syndrome research

There also appears to be a genetic component to RLS, but at this time, there’s no genetic testing available. In addition, overactive brain arousal systems seem to contribute to RLS symptoms, particularly the urge to move and the sleep disturbances, so research is needed to find a solution to the arousal. Along with helping RLS symptoms, these findings may also provide new insight into treating other cognitive and movement disorders.

Restless Leg Syndrome and Venous Reflux/Varicose Vein Disease

Doctors who treat varicose veins often listen to their patients describe symptoms like throbbing or crawling sensations in their legs, which are quite similar to the symptoms of RLS. While RLS has long been suspected as a symptom of venous insufficiency by phlebologists, more and more research is identifying venous insufficiency treatments as a possible solution for RLS patients.

68918964 - doctor in surgery room preparing for vein surgery

In fact, Dr. Simon and other vein specialists have noted the underlying superficial venous reflux present on the ultrasounds of these patients. The question that still remains, however, is whether RLS is a more severe and pronounced set of the classic vein disease symptoms? Or, is it a disease all its own?

Regardless, when ultrasound shows superficial venous reflux, it’s frequently noted by patients that their RLS symptoms lessen, or even disappear completely, when the venous reflux is treated.

If you want to learn more about varicose vein and venous reflux treatments, or how these treatments can relieve the symptoms of RLS, Vegas Valley Vein Institute can help. Contact us today to schedule your consultation!

beautiful legs with venefit

Benefits of Venefit (VNUS)

Approximately 1 in 4 adults suffer from varicose veins, the bulging, twisted veins that appear on the thighs, calves and feet. Varicose veins can be uncomfortable and unsightly, not to mention the burning, throbbing, cramping and swelling that many patients also experience.

Fortunately, the Venefit procedure is the latest development in varicose vein treatment, which can get rid of unpleasant veins with minimal discomfort and recovery time.

Find out more about the benefits of the Venefit procedure and how it can end your varicose vein and leg discomfort for good in today’s blog.

What Causes Varicose Veins?

In most cases, varicose veins are related to chronic venous insufficiency.  This is typically associated with inability of the once normal valves to close properly.  Incompetent valves in the superficial veins allow backwards flow or reflux to occur. Varicose veins can occur from long periods of time on your feet, but genetics and aging also play a role in their development. When the veins weaken, refluxing blood  pools in the veins, causing them to bulge and turn a purplish-blue color.

In severe cases, chronic venous insufficiency can cause significant complications, such as leg ulcers.

Symptoms of Varicose Veins

Varicose veins are enlarged veins that commonly appear on the lower body. Though many people think of varicose veins as only a cosmetic issue, varicose veins can cause considerable discomfort for sufferers, and may even indicate a higher risk of vascular problems.

Common symptoms of varicose veins include:

  • Veins that are dark purple or blue
  • Veins that appear twisted or bulged
  • Bleeding veins
  • Color changes or inflammation of the surrounding skin. This is often mistaken by patients and even health care providers as cellulitis.
  • Throbbing, aching and burning vein and limb pain
  • Dryness and itching legs
  • Swelling of the feet and legs
  • Muscle fatigue and weakness
  • Muscle cramping
  • Restless leg syndrome

Though rare, there are some serious complications associated with varicose veins:

  • Ulcers: Because of long-term buildup and stagnation of blood in the varicose veins extremely painful ulcers can form close to the vein, particularly on the ankle.
  • Blood clots: The varicose veins on the surface are painful and unsightly, but varicose veins can form deeper within the leg as well. When this happens, the severe swelling within the leg, which can lead to a potentially-fatal blood clot called a Deep Vein Thrombosis..
  • Bleeding: Minor bleeding with varicose veins is common, but occasionally, these veins can swell and burst, leading to significant bleeding that requires medical attention.

Some of the symptoms of varicose veins can be relieved with self-care, such as exercise or compression stockings, but severe cases require medical interventions, such as Venefit.

Though they’re often regarded as similar conditions, varicose veins and spider veins are quite different. They frequently occur due to the same underlying problem, superficial venous reflux. However,  spider veins are indeed purely cosmetic and can’t be treated directly with Venefit. It’s also important to note that Venefit is used as a medically-necessary treatment for the discomfort, pain and complications of varicose veins, and not purely as a cosmetic treatment, though one benefit of Venefit is an improvement in the appearance of the area.

What is Venefit?

The Venefit procedure is a minimally-invasive treatment option for varicose veins that uses endovenous radiofrequency ablation (RFA) technology.

RFA is used in many areas of medicine.  RFA converts an electrical current to create heat.  When this is focused to heat a small area of tissue,  radio frequency can reduce pain signals. Thus radiofrequency is commonly used to relieve chronic pain in the back, neck and joints.

Venefit allows the RF to be delivered directly inside the problematic veins.   Venefit’s endovenous RFA mechanism is used to heat and seal superficial veins such as the great saphenous, accessory saphenous, and small saphenous veins. Venefit RF may also be applied to  perforator veins. These veins are found slightly deeper in the leg, perforating the fascia of the leg to carry blood from the superficial system to the deep system of veins. Sealing or ablating problematic perforator veins is often necessary to address the underlying cause of varicose veins.

Venefit collapses the sources of venous reflux,  with an RFA catheter, which seals the vein shut and redirects the blood flow to the healthier, surrounding veins. Over time, the ablated varicose vein becomes scar tissue and is readily absorbed into the body, leaving no trace behind.

Venefit Procedure

During this procedure, a surgeon at a licensed vein clinic uses local anesthesia on the area to be treated, then inserts an IV, typically below the knee. The entire procedure is guided by ultrasound imaging.   A small diameter RFA catheter is inserted through the IV Access point into the desired vein to deliver the radiofrequency energy that heats the wall of the vein, causing it to contract and seal shut. Typically three days later, a followup  ultrasound is performed to ensure that the treated vein is completely closed.

Unlike other procedures, Venefit RFA catheters deliver consistent, uniform heat to the desired location. This  minimizes bruising and provides rapid pain relief. Patients are usually able to return to normal activity much faster than other varicose vein treatments, and experience rapid improvements to quality of life with less pain and discomfort. MOst patients return to work the same day or the next day.

Benefits of Venefit

A revolution in the treatment of varicose veins, Venefit has many benefits over similar procedures, such as:

  • Elimination of varicose veins: Unlike other procedures, the Venefit procedure can effectively eliminate varicose veins by sealing them off.
  • Minimally invasive: Previous treatment options for varicose veins used vein stripping, a painful procedure that involves pulling the vein out from under the skin with a surgical procedure.
  • Redirected blood flow: Another benefit of Venefit is that, since the varicose vein is sealed, the blood in the affected vein is safely rerouted to healthy veins.
  • No general anesthetic: Venefit uses only local anesthesia and can be completed in 20 to 30 minutes, which dramatically reduces the risks and recovery time.
  • No downtime: Venefit patients are usually able to return to their normal activity level 24 hours after the procedure.

Furthermore, Venefit and the use of Radiofrequency for vein ablation, should NOT be confused with the use of Lasers for vein treatment. Laser procedures are often called Endovenous Laser Therapy (EVLT).   While the procedure may look similar, using IV access to pass a Laser fiber, the VENEFIT RFA procedure has been shown over the past 25 years to be safer than Laser, more effective than Laser, and does not create pain as is so commonly associated with EVLT  treatments.

Discover Venefit at Vegas Valley Vein Institute

If you’re looking for relief from the discomfort and pain of varicose veins, Venefit is the right choice for you. If your desire is to improve the visual look of your legs, Venefit is the right choice for you.  This minimally-invasive, convenient procedure is one of the latest treatments for varicose veins performed by Dr. Simon and the team at Vegas Valley Vein Institute. Schedule your consultative appointment to be evaluated today!

evlt vs. rfa varicose vein treatment

Varicose veins are often a painful condition.  Your veins may become enlarged as a result of abnormalities in venous circulation. Varicose veins are typically located on the lower legs, and many people with this condition find them unsightly. In addition to the protrusion and discoloration of the veins on your legs, you can also experience heaviness and achiness in the legs, which can make work and daily activities much more difficult than it should be.

Fortunately, treatments are available for varicose veins that have proven to be effective. Two of the most popular treatments are endoscopic venous laser therapy (EVLT) and radiofrequency ablation (RFA). Learn more about your options and get an idea of which might be best for you with this handy EVLT vs. RFA comparison.

Endoscopic Venous Laser Therapy

Put simply, endoscopic venous laser therapy uses a laser to reduce varicose veins. How this works and why this works is a bit more complicated. Varicose veins are caused by nearby veins allowing backwards flow or reflux.   The blood flows backwards to stretch out nearby veins–with these becoming “varicose veins”. To treat this problem, endoscopic venous laser therapy begins by inserting a small laser fiber into the afflicted vein–the vein that is the source of backwards flow.

When the heat from a laser is applied, it boils the blood, heating the vein. This causes the refluxing vein to close. Eventually, scar tissue will form, completely sealing off the vein. Since blood has nowhere else to go when the vein is sealed off, it will start to flow through the surrounding normal veins instead. Once the source of backwards flow is eliminated, you should see the swelling go down and pain decrease.

Radiofrequency Ablation

Radiofrequency ablation is a slightly different process that accomplishes the same result. A small catheter is inserted into the target vein after applying local anesthesia. Instead of using a laser, radiofrequency waves are converted to heat that is applied directly to the inner walls of the abnormal veins in 20-second intervals, and overlapping segments  to heat and ablate the vein.

Segments of the vein will begin to close, and the catheter is pulled out along the way. Once the entire vein is ablated, blood will automatically begin to flow through healthier veins. The ablated vein will eventually turn into scar tissue and become absorbed.

We prefer to wrap the treated leg for 48-72 hours.  However patients may return to work literally within an hour . Most patients can expect to be  back to normal function in 24-48 hours.

Which is Better?

Determining which of these procedures is better can be a tough call. Both accomplish the same result and use similar tactics to accomplish it–the application of heat to the walls of the source veins. The primary difference is the heat source. EVLT uses a laser, while RFA uses radiofrequency waves.  Each can be effective. However, radiofrequency waves tend to be safer, more effective in the long term, and do not create the pain that patients experience with EVLT.

Use of laser in EVLT will take a greater toll.  The procedure can be painful and leave the legs bruised. The RFA method generally causes less bruising to your legs, which subsequently leads to a less painful recovery. If you’re trying to maximize comfort and minimize recovery time with your operation, RFA is the superior option. Keep in mind that the postoperative care is virtually the same. The primary difference is your recovery experience.

RFA Treatment at Vegas Valley Vein Institute

If you’re looking for a recovery that’s as pain-free as possible, the choice between EVLT vs. RFA is easy. Radiofrequency ablation treatment is significantly less painful during the procedure as well as in the  recovery period.

RFA is one of the primary treatment modalities utilized in Henderson at the Vegas Valley Vein Institute. Doctor Simon has the experience you can count on. Schedule your appointment today!

Vegas Valley Vein Institute

2450 W. Horizon Ridge Parkway STE 100
Henderson, NV 89052
(702) 341–7608

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(702) 472–9892

Dr. Irwin B. Simon

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(702) 735-2305

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