A Leg Up: Treating Vein Disease, Medicine's New Frontier
Q: What is vein disease?
A: There are two causes of vein disease: reflux and blockage.
“In the past, when doctors have ruled out a blood clot, they may have told patients that they don’t have vein disease or problems associated with it. Nothing could be further from the truth,” says David Draughn, MD. When standing or sitting, critical one-way valves in the veins keep blood flowing forward, uphill, against gravity, and toward the heart. Reflux, the most common cause of vein problems, occurs when those valves fail and blood flows backward. Part of the problem is that the standard vein ultrasound only looks for blood clots and is performed lying down. To find reflux, it should be performed with the patient standing up.
What are symptoms of vein disease?
“Vein symptoms can include aching, heaviness, fullness, itching, burning, and numbness. Nighttime cramping and restlessness can also be caused by reflux. Obvious signs—like varicose and spider veins—have long been downplayed by the medical community as cosmetic issues. They are not. Swelling, skin changes, and leg ulcers are serious medical conditions and can happen without a single visible varicose vein,” explains Draughn.
Blockages, on the other hand, occur in the large, deep veins of the pelvis. It’s called May-Thurner Syndrome (MTS). The condition was thought to be rare before a new diagnostic test, Intravenous Ultrasound, became available. A miniature ultrasound probe is threaded into the veins, and narrowing is measured with extreme accuracy. Large stents are used to relieve blockages greater than 50 percent. The long-standing pelvic pain associated with Pelvic Congestion Syndrome (PCS) can be caused by blockage or reflux. Though it can be difficult to distinguish PCS from other conditions, symptoms often include heaviness, cramping, dragging, and aching in the pelvis. The urge to use the bathroom and pain during or following intercourse can also be present. Visible signs of MTS and PCS include varicose veins in the bikini area, under the buttock, in the upper inner-most thigh, back of the upper thigh, or over the pubic area. If reflux is diagnosed, the ovarian vein and associated varicose veins can be embolized. Today, simple office-based vein procedures can help both reflux- and blockage-based vein disease and are a far cry from the traditional vein stripping of yesterday. “Walk in, walk out, no downtime sums it up,” Draughn says.
“Ten years ago, even as an experienced surgeon, I did not realize my own wife’s leg pain was due to reflux. After her treatment was so effective, a light bulb went on in my head. I absolutely understand how other doctors, who are great at what they do, still don’t know about veins,” Draughn admits. After 20 years as a general, vascular, and thoracic surgeon, Draughn shifted his practice to treating only vein disease. He has since become a leader in the field, participating in research and presenting at national conferences.