Venous and Lymphatic

Michael N. Tameo, M.D.
Ronald L. Nath, M.D. , F.A.C.S.

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Venous insufficiency refers to a defect, or ‘insufficiency’, of the venous system in the lower extremities causing swelling, pain, varicose veins (which can cause pain), and changes to the skin including red or brown pigmentation (known as stasis dermatitis), dry scaling, ulcers, and infection. The abnormality is usually a failure of the veins to properly return blood upward to the heart. This causes a ‘back-up’ of blood in the leg veins that raises the venous pressure, which in turn forces the fluid within blood to leak out into the tissues causing swelling. The elevated pressure also forces blood back into the smaller veins in the subcutaneous tissue under the skin causing varicose veins, which can cause pain and if located under ulcers or wounds, can prevent healing.

There are 2 types of venous insufficiency. Primary, or deep, venous insufficiency involves the deep veins in the leg and causes swelling which leads to skin changes as mentioned above and impaired healing of ulcers, wounds, and infection. Superficial venous insufficiency involves the great and/or small saphenous veins and causes swelling, painful varicose veins, reticular and spider veins, skin changes, and impaired healing of ulcers, wounds, and infection. Lymphatic insufficiency refers to a defect in the lymphatic system from trauma, previous surgery, or nerve injury. The lymphatic system helps return fluid from tissues of the extremities and thus this defect can cause swelling (lymphedema) that causes symptoms similar to that of primary/deep venous insufficiency. Complications from venous and lymphatic insufficiency include severe wounds and/or infection, which fail to heal causing gangrene and possible loss of limb.

Diagnosis of venous or lymphatic insufficiency and their associated complications requires a thorough history and physical exam by a vascular surgeon. A specific type of ultrasound of the venous system in the legs is required, which we perform at our office in our accredited non-invasive vascular lab. Patients can receive the required test and be seen by their vascular surgeon at the same visit. Occasionally, a computed tomography (CT) scan or venogram is required. Venogram involves injection of contrast dye into the vein for imaging.

Treatment of primary/deep and lymphatic insufficiency requires compression therapy with prescription-strength compression stockings. If ulcerations or wounds developed, then alternative methods of compression may be required, which incorporate wound care techniques. For severe cases or for those who are not candidates for traditional compression therapy, a compression pump may be required. Treatment of superficial venous insufficiency (including varicose veins) often requires a catheter procedure, which we perform in our office, to close the abnormal veins. If not a candidate for this technique, then microphlebectomy (removal of veins through tiny incisions) and/or sclerotherapy (injection of veins with a sclerosing agent) may be needed.