Venous Insufficiency Is Underdiagnosed: Medical Malpracitce If Ignored?

Venous insufficiency, while considered by many to be just a cosmetic issue, can lead to serious problems. Faulty valves allow blood in the veins to flow backwards as well as pool in lower extremities. The pressure from the pooled blood increases, leading to additional veins becoming elongated, dilated, and gnarled (varicose). When these veins fail, there is even greater compromise of proper blood flow back to the heart. Venous hypertension results from the force of gravity causing an increase in the pool of uncirculating venous blood. Inflammation and congestion in the tissue of the legs results from venous hypertension and is responsible for the symptoms of venous insufficiency, such as edema, pain, aching skin discoloration, leg cramping, leg fatigue, and restlessness.

When left untreated, venous issues can lead to health problems including variceal bleeding, venous ulcers, blood clots, lower extremity cellulitis, restless legs syndrome, and leg cramps. However, when doctors have patients who present with venous insufficiency symptoms, they oftentimes only check the obvious explanations rather than delve deeply into the possibility of venous reflux as the underlying cause. Unfortunately, there are a large number of people who have venous problems and do not receive proper evaluations or treatment.

Patients with this insufficiency are more vulnerable to developing cellulitis, a bacterial skin infection that can potentially be serious. It most commonly occurs on the skin of the lower legs and affects both the skin’s surface and the underlying tissue. While antibiotics can and should be used to treat the cellulitis, if the underlying cause of the cellulitis is venous insufficiency, it will return if the insufficiency is not treated.

A proper diagnosis of this vein disease involves review of the history of symptoms of the patient, physical examination, and a duplex ultrasound of the veins. To help examine the deep and superficial venous systems, a duplex ultrasound exam can be used. For a successful ultrasound, the patient should be standing during the exam so as to accurately determine blood flow concerns. Should the patient be lying down while the ultrasound is performed, venous insufficiency can be easily missed.

Treatment options can include elevating the legs whenever possible, avoiding long periods of sitting or standing, wearing compression stockings, and being active. If any of these treatments is not successful, there are surgical and procedural options that are recommended. Such treatments include vein stripping or ligation of the saphenous vein. This involves tying off and stripping out the damaged vein. Another less invasive treatment is endovenous laser ablation (ELA), which inserts a small probe with a laser through an extremely small nick in the skin. The probe is then directed to the damaged vein. Laser light pulses are then delivered into the vein which causes the vein wall to collapse and seal shut. This is considered the quickest and most effective procedure for venous insufficiency.

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