Other venous conditions and treatment

VEIN THROMBOSIS (clots in the veins)

Venous thrombosis occurs when blood clots obstruct the veins, either deep vein or superficial ones (thrombophlebitis).

Blood flows freely in arteries and veins throughout the body.

The formation of a clot within a normal artery or vein is unusual, and can be dangerous. The size and location determines the risk . If the clot occluding a cerebral artery, If the clot in a leg vein breaks off and lodges in a pulmonary artery pulmonary embolism occurs causing breathing difficulties which may progress to death. In the legs, blood clots in the veins produce swelling, edema and pain, it  should be treated promptly to prevent pulmonary embolism and chronic venous insufficiency (discoloration of the leg, chronic pain and permanent edema) known as post phlebitic syndrome.

Risk factors for blood clots in the legs (venous thrombosis):

  1. Immobilization or prolonged bed rest.
  2. Recent surgery or trauma.
  3. Recent childbirth.
  4. Obesity.
  5. Secondary to estrogen type medication or birth control pills.
  6. Procoagulant blood diseases.
  7. Anatomical condition: left iliac vein vein compression from right iliac artery, a condition known as May Thurner Syndrome, currently treated with stent placement, outpatient procedure to cure the narrowed iliac vein.


Most small clots dissolve spontaneously. In many cases it is necessary to administer anticoagulant and other medicines to prevent new clots from forming, lowering the risk of clot migration to the lungs.
Surgery is rarely needed. Sometimes, clots can be dissolved using medications that are administered through small catheters (thrombolysis).  A hematologist may need to evaluate the patient to rule out a blood disease.


Chronic venous reflux or insufficiency, occurs from damaged normal vein valves by the presence of clots or venous thrombosis. The valve damage generates venous stasis (slow circulation in the veins of the legs). The permanence of blood in the veins and poor circulation causes swelling or edema of the legs, which eventually darken the skin. Although chronic venous insufficiency is not curable, can be limited by using compression stocking, in some cases endovascular laser is the solution.

Early symptoms of chronic venous insufficiency should be recognized. Staying seated prolonged periods can cause edema or swelling in the legs, the most common symptom of chronic venous insufficiency is edema or swelling of the ankles. If swelling increases and stays for long time, the skin becomes dark, generates itching, and if not treated in time ends with difficult to treat ulcers.

Some times, iliac vein compression may cause similar symptoms (May Thurner Syndrome)


Physical exam and  noninvasive studies (ultrasound Doppler) of the leg veins to assess the functional status of both valves in the deep system and the superficial, if the superficial system is incompetent, endovascular saphenous ablation may be indicated. By eliminating the cause of venous insufficiency of the superficial system, circulation in the deep venous system can improve.
Iliac vein compression or May Thurner Syndrome is easily treated with an iliac vein stent, outpatient procedure with immediate clinical results.

In cases where there is deep vein thrombosis DVT, anticoagulants should be used.


Deep vein thrombosis is due to blood clots in the leg veins;
DVT affects veins of the thigh or leg. It occurs when a clot forms in the deep veins, the clot interferes with circulation, and may break off and embolize to the lungs.
Symptoms of DVT include pain and sudden legs swelling.

Risk factors for deep vein thrombosis include:

1 Immobilization or prolonged bed rest.

2 Surgery and recent fracture or trauma.

3 Obesity.

4 Recent childbirth and medication use as estrogens or birth control pills.

5. Procoagulant disease.

6 Left iliac vein compression (May Thurner Syndrome)


DVT usually resolves spontaneously. Treatment is intended to prevent the migration of clots to the lungs using anticoagulant, and prevents the formation of new clots. If severe, thrombolytic can be administered via a catheter into the clots.

Bed rest is recommended for short periods, keeping the leg elevated to prevent swelling. Analgesics is also shown to improve pain and inflammation.


Pulmonary embolism occurs when clots formed in veins, usually in the legs or pelvis, migrate to the lungs, causing shortness of breath that can be severe and even fatal. Pulmonary embolism causes 50,000 deaths annually in the United States.

The signs of pulmonary embolism include:

Shortness of breath, chest pain that worsens with breathing, increased heart rate (tachycardia), hemoptysis (blood in sputum). Massive pulmonary embolism can lead to heart failure and death.

If pulmonary embolism is diagnosed and treated promptly, fatal complications are rare.


The variceal ulcer is a skin would open below knee, usually at the medial ancke, the wound is difficult to heal because of insufficient veins,

Variceal ulcers, tend to become infected, changing reddish-purplish discoloration of the surrounding skin thins and becomes fragile.  The delayed diagnosis and treatment of dilated saphenous vein and varicose veins, are the main cause for the appearance of varicose ulcers. Symptoms include red wound scarring, which turns purple in the ankle region, which leads to swelling, usually occur in patients with a history of varicose veins untreated or inadequately treated.


Isometric elastic compression stocking are used to improve blood circulation. Wound care should be performed with appropriate dressing regularly. It is essential to evaluate the superficial and deep venous system, where the superficial system reflux (saphenous, perforator vein or collateral) to be treated endovascularly (endovascular laser)also the feeding veins should be removed (phlebectomy) or foam sclerosed under ultrasound guidance. The most common cause of a varicose ulcer, is lack of diagnosis and appropriate treatment of superficial vein  reflux.
It is an office procedure, and the ulcer heals within a few weeks, even if they have been opened for months or years.