Guest Post by ACP Member
Charles R. Rogers, M.D., Morrison Vein Institute
A question often asked by our patients, and probably wondered by many more, is why do we encourage the use of ultrasound technology in both the diagnosis and treatment of patients with venous disease?
It is a legitimate question and one that deserves explanation. Let me start by explaining that when a patient presents with symptoms of venous insufficiency, i.e., “spider veins” (telangectasias), visible varicose veins, and complaints of leg fatigue, aching, itching and restlessness or edema (swelling of the ankles and lower legs), what is visible to us is usually not the whole story. It is sort of like the “iceberg phenomenon” – the real danger or problem is below the surface. Veins, whether they be deep, invisible under the surface of the skin, or visible on the surface, enlarge for one reason only; increased pressure exerted on the thin walls of the veins by an increased volume of blood.
Under normal circumstances, the superficial venous circulation, the one with which we are primarily concerned, carries only about 10% of the volume of blood returning to the heart from the legs. The other 90% is returned via the deep venous system. The venous system has no heart or “pump” to help propel the blood it receives back towards the heart. It relies on muscle activity to massage the veins and direct blood flow towards the heart and the interspersion of valves to prevent gravity from pulling blood in a direction away from the heart. It is the disease, destruction or absence of the valves that leads to the condition that we refer to as venous insufficiency or “reflux.”
Think of the vein as a liquid-filled tube (which it is) say 12 inches long. If you stand it vertically and place a valve or baffle in the middle of its’ length, the pressure on the wall of the tube, if the valve is closed, will be the same at the 6 inch level as it is at the bottom of the tube. If the valve is removed or open, the pressure at the bottom will be increased and the tendency will be for the tube to expand to accommodate the increased pressure.
In addition, in our circulation, we have the dynamic effect of blood flow. The absences of, or incomplete closure of, valves allows blood to flow backwards (reflux) increasing both volume and pressure below the point of reflux further tending to dilate the veins. It is precisely these points of reflux that ultrasonography (ultrasound) allows us to identify and treat.
Spider veins often are the result of increased pressure from underlying veins, invisible from the surface, that can no longer accommodate the increased pressure and volume of blood they contain. By identifying these underlying veins with ultrasound technology, injecting and destroying them, we force blood from the superficial to the deep veins where it belongs. There are other, more serious, consequences of venous insufficiency that can lead to debilitating circumstances that we cover with our patients in our screening procedure. When we recommend an ultrasound scan, it is only because we suspect an underlying pathology that is best and most accurately identified by this technology. It further enhances our ability to devise and advise a treatment plan that will most effectively treat your individual problem and insure the most successful outcome.
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