Ingalls Vein Clinic
Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weakened and don’t close properly, they allow blood to flow backward, a condition called reflux. Veins that have lost their valve effectiveness become elongated, rope-like, bulged and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in a thigh vein called the great saphenous vein, which leads to pooling in the visible varicose veins below.
Chronic venous disease of the legs is one of the most common conditions in the United States, affecting 50% of people age 50 and older. It affects up to 55% of women and 45% of men. Besides being cosmetically unattractive, varicose veins can cause chronic leg pain and debilitating fatigue. The affected veins can also develop blood clots.
Laser Vein Ablation
This minimally invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, an Ingalls interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein, and guides it up the greater saphenous vein into the thigh. Laser or radiofrequency energy is then applied to the inside of the vein, heating and then sealing the vein closed. By closing the greater saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.
Laser vein ablation is a quick, effective procedure that involves minimal discomfort and represents a vast improvement over the traditional option of vein stripping and ligation surgery that was often painful and required up to six weeks of recovery. After the procedure, a patient can literally walk out of the office and resume normal activities within 24 hours. Laser vein ablation boasts a 95-percent success rate.
Vein mapping helps determine if you are a candidate for laser vein ablation.
Ambulatory phlebectomy is a minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny slit-like incision or incisions using a special set of tools. The procedure is done under local anesthesia and typically takes less than an hour to perform. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.
Sclerotherapy treatment is a non-surgical procedure that can be used to treat some varicose veins and nearly all spider veins. The procedure involves injecting a solution directly into the vein, resulting in a reaction that progressively shrinks the varicose vein. If the vein is labeled as "diseased," it may necessitate several treatments to fully fade away.
Veinwave is a safe, minimally invasive procedure for the treatment of tiny spider veins. The Veinwave device produces a tiny amount of heat called thermocoagulation that eradicates spider and thread veins. Depending on the severity of your condition, you may need more than one session.
Peripheral artery disease
Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking. Clinically, this is referred to as intermittent claudication.
Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs. Often, you can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet.
Peripheral artery disease symptoms include:
- Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs (intermittent claudication)
- Leg numbness or weakness
- Coldness in your lower leg or foot, especially when compared with the other leg
- Sores on your toes, feet or legs that won't heal
- A change in the color of your legs
- Hair loss or slower hair growth on your feet and legs
- Slower growth of your toenails
- Shiny skin on your legs
- No pulse or a weak pulse in your legs or feet
- Erectile dysfunction in men
If peripheral artery disease progresses, pain may even occur when you're at rest or when you're lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.
Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up in your artery walls and reduce blood flow. Although the heart is usually the focus of discussion of atherosclerosis, this disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease.
Less commonly, the cause of PAD may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.
Initially arterial ultrasound will be performed to differentiate arterial disease from other causes of leg pain such as venous and peripheral nerve disease. The first-line study is the ankle brachial pressure index (ABPI/ABI). When the blood pressure readings in the ankles is lower than that in the arms, blockages in the arteries that provide blood from the heart to the ankle are suspected. An ABI ratio less than 0.9 is consistent with disease; values of ABI below 0.8 indicate moderate disease and below 0.5 imply severe ischemic disease.
If ABIs are abnormal, the next step is generally a lower limb Doppler ultrasound examination to look at the site and extent of atherosclerosis. The definitive test for peripheral artery disease is angiography, which is both diagnostic and potentially therapeutic.
Angioplasty and Stenting
During an angiography, an Ingalls interventional radiologist, using imaging guidance, threads a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then the interventional radiologist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases, this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip. Balloon angioplasty and stenting have generally replaced invasive surgery as the first-line treatment for PAD. Peripheral angiography is usually performed on an outpatient basis. Patients will need to stay for a number of hours after the procedure to assure the access sites are stable and no further bleeding will occur. Afterwards, the patient should expect symptoms to start resolving almost immediately.
For more information about Ingalls Vein Center in Tinley Park, please call Vein Clinic Coordinator Joyce Cox at 708.915.7518.