The Venous High Noon – When beauty comes before function
The venous high noon – is not just a saying! Very often we have spoken and written about the various treatments for varicose veins – as well as the different views of vein specialists and patients.
The varicose vein disease is initially regarded as a functional – chronic disease. The existing pathological function – defective, non-closing venous valves – leads over the years to chronic changes in the skin, subcutaneous tissue and also the muscles. Visible changes in the skin have different characteristics – from the spider veins or reticular veins to the strong side branches or truncal varicose veins.
In an advanced stage, we then regularly see chronic skin changes, from simple small brown spots to large brown discoloration of the ankle and lower leg (Cafe au lait – spots).
The Venous High Noon – Optical signs show pathology
All these visual signs indicate pathological changes in the venous system and it is up to us to pinpoint these changes. Often we see surprised patients, who come in the spring only to „ugly“ ugly spider veins leave. The specialist standard leaves us no other option – functional therapy is mandatory in the first place!
Also besides, however, above all, the change of the veins in itself, and in particular of the deep and superficial leg veins of us to take into account. In addition to the hydrostatic pressure, which increases in the lower leg veins, the more venous valves are defective, the pressure of breathing, laughting, and pressure in the chest and abdomen plays a major role.
The Venous High Noon – Thrombosis
Alternating pressure creates unequal blood flow and these irregularities can lead to a devastating effect – the spontaneous coagulation of venous blood – on the smallest cause. We then speak of superficial thrombosis (phlebitis) or deep vein thrombosis. Causes are lack of fluids, long sitting, high outside temperatures, intensively performance sports – individually or in interaction. The result is travel thrombosis, spontaneous office thrombosis, sports thrombosis, avian thrombosis and so on…
We will never forget when Discus – Olympic champion Robert Harting came to us in the summer of 2011 and told us completely disconcerted about a Ukrainian thrower who died in a training camp from a pulmonary embolism. And he wanted to get rid of his varicose veins very quickly. Here was the experienced trigger, in combination with a regular performance weakness of Robert at the beginning of the altitude training camp in Russia, Mexico, and other countries.
The Venous High Noon – Pulmonary embolism
And we will not be able to forget the experience of the author, in the summer of 2008. The author was intensively on the road every day with a racing bike and cycled to work in the center of Berlin. It was a very warm summer and lacked the liquid balance. And it was not known yet that there were truncal varicose veins. Sure, you saw only retinal veins and spider veins…
After superficial vein thrombosis – although treated with heparin syringes – thrombosis of the deep knee vein occurred – and pulmonary embolism of the right pulmonary artery. On a campground, on the weekend, while swimming in Lake Userin, the breathing was suddenly gone. Colleague PD Lahl was able to perform the diagnostics very quickly on the next working day with the ultrasound – and then began 1 year of self-therapy using Arixtra injections.
What remained is a post-thrombotic syndrome on the left leg – visible in the video because of the marked swelling and the increased occurrence of retinal veins and side branches of varicose veins compared to the right, healthy leg.
It was probably a bit of great luck that this course was without any other complications. Perhaps You understands therefore also our – understood by Saphenion as a diagnostical duty – at first view of the function of the venous system, at the second view of the cosmetics.
The Venous High Noon – Postthrombotic syndrome
Post-thrombotic syndrome (PTS) occurs in approximately 20-50% of patients after deep venous thrombosis and significantly affects patients‘ quality of life.
In the first place, swelling and congestion in the lower leg, which increase in temperature depending on the summer. A permanent increase in the circumference of the affected leg is a sure sign. Also besides, there are skin changes, brown discoloration due to intercalation of blood and tissue breakdown products, increase in spider veins and retinal veins, the formation of strong lateral and connective varicose veins. And it comes to increased skin inflammations, dermatosis, and poorly healing wounds. The endpoint here is the leg ulcer.
Therapy options are conservative in the post-thrombotic syndrome of leg veins. Compression, physiotherapy, and massages are the possible treatment options here, and – the unconditional therapy of existing varicose veins.
It is important to exhaust all these conservative therapies. Since PTS is extremely rarely life-threatening and limb loss is unlikely, varicose vein surgery should be minimally invasive. Therefore, the endovascular techniques (vein glue, radio wave, laser, microfoam) are the first-choice treatment.
A minimally invasive surgical technique is also advisable because the postthrombotic syndrome is a significant neoangiogenesis of the side branch and perforator varicose veins. Even existing truncal varicosis, no matter in which region, will increase dramatically. These include extensions of the vein diameter, recurrent phlebitis (superficial vein thrombosis) and further functional aberrations. Therapy with the usual radical surgical procedures (stripping, side branch excision) means an increase of op-related complications.
The Venous High Noon – The office hours reality
Unfortunately, in our office hours, we repeatedly come across patients who speak casually of thromboses and pulmonary embolisms and report that tablets have been administered and no varicose vein diagnosis has been performed. For us, an alarm signal that varicose veins as the cause of these acute diseases may not always be taken very seriously.
Regardless of this, it is very important in our first contact with varicose vein patients to point out the functional component again and again!
The venous high noon – Function first, then cosmetics!
Utzius – Copenhavn black and white
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