Diseases and conditions

What is venous disease?

Venous disease refers to a class of conditions in which the veins have problems sending blood from the legs back to the heart. There are two types of venous disease: Superficial and deep.

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Superficial venous disease
- Varicose veins
- Venous reflux
Deep venous disease
- DVT
- Pulmonary embolism (PE)
- Post-thrombotic syndrome
- Treatments

Superficial venous disease

Superficial veins are those close to the surface of the body. Superficial venous disease is a common clinical problem. Superficial venous diseases include venous reflux (where the tiny valves that normally force blood back up towards your heart no longer function, causing blood to pool up in the legs, and the veins of the legs to become distended), varicose veins, and superficial venous thrombosis, which is the combination of thrombosis and inflammation in a superficial vein.

Superficial venous reflux can be a significant contributor to wounds caused by chronic venous insufficiency. Superficial venous reflux has been associated with an increased risk of deep vein thrombosis.

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Deep venous disease

Deep veins in your body are far from the surface and typically have an artery with the same name close by. Deep vein thrombosis (DVT) occurs when blood clots form in the veins that move blood from various parts of the body back to the heart and lungs. Deep vein thrombosis can occur in any vein in your body, but it most commonly forms in the legs. A leg DVT can be in a small vein or can span the entire leg.

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Treating superficial venous disease

Varicose veins

Varicose veins are swollen, enlarged veins that are clearly visible just under the surface of the skin. This is a common condition caused by problems with the valves within your veins that are designed to keep blood flowing toward your heart. If the valves are weak or damaged, blood can back up and pool in your veins (venous reflux) which causes them to swell. Many factors can raise your risk for developing varicose veins, including family history, older age, female gender, pregnancy, obesity, prolonged standing or sitting, blood clots, and prior trauma.

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What are the symptoms of varicose veins?

For some people, varicose veins cause pain, blood clots, or sores. This ailment usually occurs in the legs, but also can appear in other parts of the body. Symptoms of varicose veins include:

Swollen, visible veins
Bumpy appearance of veins
Skin irritation
Legs feel heavy

How do IRs treat varicose veins?

Endovenous laser ablation treatment (EVLT) is a minimally invasive treatment that uses heat to close off problematic veins and relieve the symptoms they cause. Using imaging guidance (guided by X-ray images), the interventional radiologist threads a thin laser fiber into the problem vein through a tiny needle. Next, they numb the length of the vein to minimize discomfort during the heating process, and the laser heat causes the vein to close. Once the problem vein is closed, blood will flow through the remaining healthy veins. This is all accomplished while you rest comfortably. You can immediately return to most normal daily activities.

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Radiofrequency ablation is a similar treatment, using a fiber that emits radiofrequency energy instead of heat from a laser fiber.

A variety of non-thermal treatment options are also available for varicose veins. These treatments include:

VenaSeal cyanoacrylate: An injection of medical glue into the vein to cause closure.
Clarivein: A rotating catheter is guided inside the vein to evenly disperse a chemical solution that results in complete closure.
Varithena: A foam material is injected into a varicose vein to improve symptoms or appearance.

The main advantage of all of these techniques is the avoidance of multiple needle sticks for local anesthesia. There is also a decreased risk for potential nerve damage that can occur with burns.

Sclerotherapy: Sclerotherapy is the direct injection through a tiny needle of a chemical irritant into a vein to close the vessel. This technique is often used to treat smaller veins such as spider veins. A variety of materials can be used to irritate the vein lining, which causes them to shrink and close.

Superficial venous thrombosis occurs when a superficial (just below the skin’s surface) vein becomes swollen or inflamed due to a blood clot. If conservative treatments such as wearing support stockings (if your leg is affected), taking over-the-counter pain medications, or applying a warm compress to the area do not help, an interventional radiologist may perform a treatment like EVLT or sclerotherapy (see above) on the affected vein.

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Treating deep venous disease

Common symptoms for DVT include swelling, pain and tenderness in the limb; a tired, heavy feeling in the limb; abnormal coloring, or surface veins becoming more visible. You are at increased risk of DVT if you have been immobilized for long periods (for example, bed rest, hospitalization and long plane flights); have had recent surgery, recent trauma, cancer, current infection, a history of previous DVT; or have a family history of DVT.

Learn more about the signs, symptoms and risk factors that contribute to blood clot development.

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Pulmonary embolism

Sometimes, these clots can travel to the lungs, becoming a pulmonary embolism (PE).

When PE occurs, it is usually small enough so that blood can flow around the clot and into the lungs. However, in some cases, the clot can be large enough to block much of the blood flow to the lungs. In severe cases, this can lead to heart failure and/or death. Common symptoms for PE include shortness of breath, pain when taking a deep breath, a cough with a discharge that has a frothy pink quality and increased heart rate. Together, DVT and PE are called venous thromboembolism (VTE). VTE can be life threatening.

Post-thrombotic syndrome (PTS) is a problem that can develop in nearly half of all patients who experience a deep vein thrombosis (blood clot) in the leg. Symptoms include chronic leg pain, swelling, redness and ulcers (sores). PTS can make it difficult for you to get around, and the pain and discomfort can make your life less enjoyable. The best thing to do is to prevent this problem whenever possible.

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How do IRs treat deep vein thrombosis?

Mechanical treatment of deep vein thrombosis comes in various forms: angioplasty and stenting, thrombolysis, and IVC filter placement. With each treatment, an interventional radiologist makes a small incision to access the femoral vein (the large vein in the leg). Guided by X-rays, the doctor inserts a catheter (a thin plastic tube) through the vein to the DVT site.

Angioplasty and stenting: After treating the blood clot, the IR might find stenosis, which is a narrowing in the vein the limits blood flow. The stenosis can be treated by angioplasty, where inflating a balloon makes the vein larger. In some situations, the interventional radiologist also may opt to use a stent, a tiny expandable tube that props open the vein to open up blood flow and prevent the vein from narrowing again.

Thrombolysis: Using imaging guidance, IRs place specialized catheters within a blood clot. These catheters will allow clot-melting medication, called tissue plasmogen activator (TPA), to be injected directly into the clot. This allows for complete treatment of the blood clot over one to two days, rather than taking several weeks to months as is common with other treatments alone. During this treatment, people are placed in the intensive care unit (ICU) for closer monitoring. In some cases, this can be offered in conjunction with mechanical thrombectomy. With mechanical thrombectomy, the interventional radiologist guides a device through the femoral vein to the DVT site. Once there, the doctor uses the device to mechanically break up the clot into smaller pieces and then removes the clot pieces.

Inferior vena cava filter (IVC filter): For people who cannot tolerate other treatments, a filtering device may be placed within the inferior vena cava, the large vein in the abdomen that drains the blood from the legs. The IVC filter acts like a small net, allowing for normal blood flow, but catching any traveling blood clots, preventing a DVT from moving to the lungs. Additionally, most IVC filters will be removed once the blood clot has cleared or when you can begin taking blood thinners to treat the clot.

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Chronic venous insufficiency

Chronic venous insufficiency describes the disorder of veins preventing the backflow of blood back to the heart, which commonly leads to pooling of blood in the legs.

May-Thurner syndrome

When the right iliac artery (the main blood vessel for the right leg) rests on top of the left iliac vein (the main vein in the left leg), causing pressure, the result is May-Thurner syndrome. This pressure on the left iliac vein can cause blood to flow abnormally, which can have serious consequences. May-Thurner syndrome is also known as iliac vein compression syndrome, iliocaval compression syndrome, or Cockett syndrome.

Approximately 2% to 5% of those with chronic deep venous insufficiency of the left leg may have May-Thurner. Outside of interventional radiology, May-Thurner syndrome can be difficult to diagnose, but it should be considered as it has been shown to increase the likelihood of developing DVT.

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Additional information

Visit RadiologyInfo.org for Patients.

Blood Clot Awareness, Advocacy and Action Toolkit

Disclaimer: SIR is providing this information as a public service. SIR assumes no liability, legal, financial or otherwise for the accuracy of this information or the manner in which it is used. SIR does not offer medical advice. This information is being provided for informational purposes only and should not be used to replace professional medical advice. It is best to seek advice and attention from your physician or qualified health care professional.

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Know the signs

Millions of Americans are impacted by deep vein thrombosis (DVT)/pulmonary embolism (PE). Despite longstanding efforts by stakeholders to mitigate the
distressing impacts of blood clots, Americans continue to face disability, suffer serious illness, and risk death due to these conditions. This toolkit will help you learn the signs and symptoms of a blood clot so you can seek appropraite care.

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