Specialty Team Provides Comprehensive Care for Venous Diseases

Imagine "Mary," a mother of 3, complaining of achiness in her legs. A hairstylist, she stands most of the day and has lived with varicose veins for years. But now her legs feel heavy, they itch and she reports feeling more fatigued than normal.

Patients experiencing scenarios like this may be suffering from venous insufficiency, a common vascular dysfunction in the legs that affects 40% of the U.S. population. Most Americans do not seek treatment, leaving them at a higher risk of developing more serious conditions later.

The University of Kansas Health System is one of the only organizations in the area to offer comprehensive venous care. Our multispecialty team of vascular specialists, vascular surgeons, interventional radiologists, general physicians, hematologists and wound care specialists works collaboratively to close the patient care gap. Our shared goal is to elevate outcomes for all venous diseases – from simple spider veins to rare or complex diseases that require surgical reconstruction.

Our organization further distinguishes itself as the only one in the region to treat rare, life-threatening venous disorders, including:

• May-Thurner syndrome, in which patients experience significant, unilateral left-leg swelling and pain caused by the right iliac artery compressing the left iliac vein. If left untreated, the disorder can advance to massive deep vein thrombosis. We can treat patients with minimally invasive venograms (X-rays) and stenting to alleviate compression.
• Phlegmasia, in which extensive deep venous thrombosis throughout the vena cava, the iliac vein and the veins of the legs causes massive swelling of the leg. Our unique, aggressive treatment removes the clot burden, quickly relieving symptoms and reducing longer-term post-thrombotic complications.

Our specialty team begins with a thorough history and physical exam to evaluate the disease and its severity. If the patient’s symptoms are significant, we progress to venograms or ultrasound testing, which gives us a better understanding of the veins’ condition and helps us determine the best course of care.

For most patients, treatment involves one of the following safe, minimally invasive procedures, performed in our office with local anesthetic:

• Endovenous ablation uses image-guided, radiofrequency or laser energy to cauterize and close diseased saphenous veins.
• Microphlebectomy removes protruding varicose vein clusters through tiny incisions in the leg that are closed with tape and heal without scarring.
• Endoluminal thermal ablation threads ultrasound-guided laser fiber into varicose or diseased perforator veins. The laser light causes the artery or vein to shrink and eventually disappear.
• Sclerotherapy injects a chemical solution into spider veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to clot. Over a period of weeks, the vessel turns into scar tissue and eventually fades.

Despite temporary bruising and soreness, most patients begin feeling better after one treatment and return to normal activity the next day.

After treatment is completed, we follow up with each patient to ensure he or she is satisfied with the results. If so, we recommend follow-up care on an as-needed basis. Annual visits are not necessary.

To help manage their diseases and reduce recurrence, we encourage our patients to incorporate these healthy habits into their daily lives:

• Compression stockings
• Exercise
• Good skin care
• Achieving or maintaining a healthy weight

Venous insufficiency can affect any age – even children and teenagers – but is slightly more common in women who have had multiple pregnancies.

Patients with valve damage from blood clots or family histories of the disease are at higher risk. In fact, when patients are released from our care, we encourage them to see their primary care physicians regularly to screen for future recurrences, which are likely due to the disease’s genetic nature.

Most insurance companies now realize that, if left untreated, the simple cosmetic issues most associate with venous insufficiency can progress to serious medical issues. For that reason, they now cover most treatments.

Signs of progression include:

• Noticeable swelling in the legs
• Skin damage indicated by darker areas, rashes, open sores or infections with cellulitis
• Bleeding from surface veins
• Superficial phlebitis (blood clots within the varicose veins)
• Life-threatening deep venous thrombosis

Because the condition can worsen over time, we encourage referring physicians to consult us earlier rather than later as they manage patients’ venous diseases. Early detection equals less invasive treatment, faster patient recovery and an improved quality of life.

Our standard of care and range of services extend beyond what other organizations can offer, making The University of Kansas Health System the destination for venous disease care.

Dr. Cho is a vascular surgeon at The University of Kansas Health System. She is board-certified in vascular surgery.