Venous Disease


What is Venous Disease?

Venous diseases refer to the problems that can happen in the veins. The function of the veins is to carry de-oxygenated blood from the peripheries of the body and other organs to the heart, which is then sent to the lungs for oxygenation.
A variety of problems can occur in the veins. The most common amongst them is varicose veins. Other problems are Deep vein Thrombosis (DVT), pulmonary thromboembolism, thrombophlebitis, fibrotic strictures and rarely venous aneurysms.
A varicose vein is seen most commonly in the legs, and extremely rarely in the upper limbs. Occasionally these varicosities can occur due to an abnormal communication between the artery and vein, most commonly traumatic, and rarely congenital. Occasionally varicosities undergo thrombosis and this can be a reason to obtain specialist opinion.
Deep Vein Thrombosis (DVT) is a potentially life and limb threatening condition. It can occur due to a variety of reasons involving the blood, mobility of the patient, and the vessel wall. Problems in any one of them can lead to the development of venous thrombosis. Venous Thrombosis can occur in any part of the body, most commonly in the legs. DVT occurring anywhere else like abdominal veins, cerebral veins and upper limb veins need further

evaluation to look for hypercoaguable state (condition wherein the blood has a increased tendency to clot). Treatment of DVT is like an emergency due to the risk of Pulmonary Thrombo Embolism (PTE) which can be life threatening. In the chronic stage, or even due to inadequate treatment (either in drug dosage or duration of treatment), it can lead to Post Phlebitic Syndrome characterized by the presence of pain, swelling, blackish discolouration around the ankle and even ulcers, which can be very difficult to heal.
Treatment of DVT in the acute stage involves anticoagulants like Heparin or even Low Molecular Weight Heparins or Fondaparinux and gradually switched over to long term oral anticoagulants like Acetrom/ Warfarin or Anti Xa inhibitors. Monitoring of drug dosage is necessary with Acetrom/ warfarin and INR maintained in the therapeutic range.
Rarely these medications cannot be given due to certain risks, in which situation; placement of an IVC (Inferior Vena Cava) filter becomes life saving should DVT and PTE occur. Compression stockings form a integral part of the treatment of these venous disorders, without which the treatment is incomplete.
Occasionally stenotic disorders develop in the venous system, like May Thurners syndrome in the iliac veins, hepatic venous stenosis / web, or IVC stenosis / web. These disorders can be a cause for the recurrence of varicose veins post treatment, and can also lead to thrombosis. Their treatment is with angioplasty- stenting with special venous stents.