By Joseph Magnant, MD, FACS –
Approximately 40 Million adults in the USA are affected with severe superficial venous insufficiency, and many of these patients may have edema or swelling based on increased venous pressure in the legs caused by their leaky veins. Heredity has been firmly established as the primary cause of venous insufficiency although there are a number of other factors which contribute to worsening of the signs and severity of venous insufficiency. Pregnancy, overweight and obesity, sedentary occupations, advanced age, and any other conditions which increase intra-abdominal pressure are some of these factors. Many patients have been told that their swollen painful legs are related directly to their obesity and that weight loss alone will remedy their problem. Unfortunately, the symptoms of painful legs related to severe swelling often prevent these patients from performing the very exercises prescribed to lose their excess weight. The cycle becomes an impossible one for the overweight patient to break out of. The graph below reviews the increase in the prevalence of overweight and obesity in the general adult population. As is quite evident the prevalence of overweight and obesity is on the rise and as this trend continues it is expected that a greater percentage of patients with familial venous insufficiency and varicose veins will likely present with more advanced signs and symptoms of the disease. One in five adult Americans has significant superficial venous insufficiency and in women over the age of 50, one in three is affected. When the prevalence of insufficiency in these populations are crossed with obesity and overweight statistics, it becomes clear that there are many overweight and obese adults with severe venous insufficiency, many of whom have been told their leg symptoms are primarily a weight induced problem and have likely given up on any hope of remedy of their leg discomfort and leg vein problems.
Although it cannot be denied that overweight and obesity play an important role in exacerbating the condition of venous insufficiency, the underlying cause is HEREDITY. Rather than insist on weight loss alone as the primary treatment of the symptoms and signs of venous insufficiency, we must insist on venous insufficiency evaluation and diagnostic examination with modern ultrasound techniques in overweight and obese patients who present with significant symptoms. These may include but are not necessarily limited to swollen, painful legs, reddened and inflamed legs, varicose veins, discolored skin or ulcerations in the ankle regions or lower legs, nighttime leg cramps or restless legs syndrome. Patients with weight problems and any of the above symptoms should be encouraged that there may be a minimally invasive treatment for their vein problems which may give them the freedom to live without pain in their legs and begin a more meaningful journey to weight reduction through active exercise. Take control of your life now, empower yourself to seek a thorough evaluation of your lower extremity venous system for leakiness, not just for clots in the veins, rather than resigning yourself to accepting the dismissive explanation that your weight or obesity is the sole cause of your leg symptoms.
Until the year 2000, the only treatments for venous insufficiency (manifest as large varicose veins, skin ulcerations or bleeding varicose veins) were compression hose or vein stripping. Due to the invasive and painful nature of vein stripping, surgical treatment for venous insufficiency was limited to patients with recurrent ulcerations around the ankles or varicose vein related bleeding episodes. Endovenous closure was introduced in 2000 and has significantly changed the landscape for patients with venous insufficiency. Since introduced, endovenous closure (sealing of the leaky veins with a small catheter) has been used successfully to treat many different patients. Overweight and obese patients have been able to have successful treatment of their venous insufficiency and relief from their disabling symptoms prior to developing the end result complications of venous ulceration or hemorrhage and can be safely treated for the less advanced yet still painful presentations of severe swelling and redness of the legs, bulging varicose veins and complaints of nighttime leg cramps and urination. The availability of this minimally invasive and very effective procedure to this previously ignored population of patients with symptomatic venous insufficiency has resulted in a surge in the number of patients being referred either through their physicians or directly for venous evaluation. Since the superficial venous system (rather than the deep system) is responsible for the majority of patients’ problems with the advanced signs and symptoms of venous insufficiency, it seems only appropriate to offer patients a scientific evaluation and a more definitive therapy when appropriate, earlier in the course of disease process rather than making them suffer the pain and discomfort of venous hyperten- sion indefinitely. Complications such as bleeding, ulceration and cellulitis require frequent emergency room visits and hospitalizations and the goal should be the avoidance of these serious complications.
Untreated venous insufficiency in the overweight or obese patient makes it nearly impossible for them to the lose their weight, which further complicates their medical conditions such as diabetes, hypertension, high cholesterol and overall cardiovascular health.
They often also report higher incidences of depression, anxiety and other psychological disorders which often are improved after treatment of their venous disorders as their chronic pain resolves and their self esteem improves as they are able to begin their exercise programs in earnest and turn their lives around.
The photos above demonstrate the before and after photos of a patients who lost 120# and still had large varicose veins which were more noticeable after weight loss due to the loss of fat around the veins. He underwent successful treatment with endovenous ablation and the photo on the top right shows the final result with complete resolution of the large varicose veins. Weight loss is a great goal, but overweight or obese patients with vein disease should not be mandated to lose their weight before having their vein evaluation and possible treatments.
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