Sarasota Edition


By Federico M. Richter, MD

RESTLESS LEG SYNDROME AND VENOUS INSUFFICIENCY Venous insufficiency is the underlying problem that leads to varicose veins and much more. It is estimated that at least 80 million Americans,

more than 25% of the U.S. population, suffer from chronic venous insufficiency and over 60 % has some form of venous disorders. Nearly 70% of all women and 30% of men will develop some type of venous disorder due to insufficient blood circulation. It occurs when faulty valves allow the blood in the veins to flow backwards and pool in the lower half of the body. This increased pressure inside the vein causes additional veins to become elongated, dilated and twisty (or varicose). In turn, these veins fail, leading to greater compromise of proper blood flow back to the heart. Under the force of gravity, the increasing pressure of uncirculating venous blood leads to venous hypertension. Venous hypertension causes inflammation and congestion in the tissue of the legs and is responsible for the symptoms of venous insufficiency, which can include edema, pain, aching, skin discoloration, leg cramping, leg fatigue and restlessness.

Venous insufficiency can be the underlying cause of multiple other conditions, including Deep Vein Thrombosis (blood clots in your legs), lower extremity cellulitis (life threatening skin infections), variceal bleeding, venous ulcers, restless legs syndrome and leg cramps just to name a few. Physicians often only check some of the obvious explanations for the leg cramps like electrolytes imbalance (potassium, calcium and magnesium levels) neuropathy or endocrine conditions and do not explore the possibility of venous reflux as an underlying cause.

Restless leg syndrome is a condition marked by unpleasant leg sensations at bedtime. Restless leg syndrome frequently leads to insomnia. The cause of Restless Leg Syndrome is unknown in most individuals, but many conditions have been associated with it.

RLS is common in patients with both saphenous and reticular varicose vein disease ( unsightly veins), and can respond frequently and rapidly to EVLT (Endo Venous Laser Treatment) and sclerotherapy (injection of sclerosant to close the veins). Both outpatient procedures with no down time.

All this subpopulation of RLS sufferers should be considered for phlebological evaluation of venous insufficiency should be checked as a possible cause, as correction of the vein reflux provides long-term and likely permanent relief of symptoms before being consigned to chronic drug therapy with potential side effects.

Making a Diagnosis
Correctly diagnosing vein disease involves a review of the patient’s history of symptoms, physical examination and a duplex ultrasound of the veins. The duplex ultrasound exam can help identify the presence of reflux and its location, as well as determine the patency of the deep and superficial venous systems. The leg is examined from the groin down to the ankle.

“Often, when you send a patient for an ultrasound evaluation for venous disease, the technician mistakenly has the patient lie down. This occurs because many technicians are trained to look for deep vein disease; however, this positioning will result in an inadequate exam, and superficial venous insufficiency won’t be diagnosed. It’s important to send patients to a specialized vein center, as their sonographers and doctors are trained to detect venous insufficiency and can diagnose it with more accuracy.”

Studies show that the treatment of venous insufficiency often relieves symptoms of Restless Leg Syndrome. According to a study in the journal Phlebology, in patients with restless leg syndrome and venous insufficiency, 98% of patients experienced relief from restless legs syndrome symptoms by treating their venous insufficiency, and 80% had long-term relief.

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