Chronic Venous Insufficiency - Long term implications?

Hi all,

After a lot of confusion about WTF was going on, I was diagnosed with Chronic Venous insufficiency in my right leg. I got an ultrasound and they determined that there is a valve in my mid thigh (one of the superficial veins near the skin) that has a failed valve and thereby causing a significant amount of static pressure to build up in my ankle. I actually even had venous ulcers forming in my ankle (again, I had no idea WTF was going on, I am 30 years old, it actually took some bouncing around to different specialists before they figured it out) along with significant discoloration and varicose veins.

They sent me home and told me to wear compression stockings, and after wearing them on and off for several months now, all the ulcers have healed and even the swelling and discoloration dropped, but has sort of plateued now. Now the vein clinic wants to bring me back for a laser ablation and removal of the varicose veins in the foot. Looking at around a 10k price tag, and of course I get to cover about 90% of it due to my freedomland deductible. The clinic was very unconcerned whether I returned or not, and seemed to let on that it wasnt a huge deal.

So my question is to TGR: Has anyone else dealt with this condition? How did it progress? Did it eventually prevent you from being able to ski/trail run/ bike and all the activities you enjoy doing? I am wondering if it is better to just manage the condition rather than get a significant proceedure done? Should I get it done when the symptoms are worse and I cant do that activities I want to do? Is it better to nip it in the bud now when I am young? Should I just buy a round trip to India and call some people to get this done?

Would really appreciate some perspective, thanks.

Not exactly the same, but I ripped my calf off in a tree falling incident about 20 years ago, which required major surgery including an arterial graft, and left me with venous insufficiency. I needed to wear compression socks pretty constantly for a few years, and still do when skiing (not because I need to, but because it’s an easy option with lots of great choices) and for flights and long drives. I lead a very active life (might be different if I had a desk job), and found the symptoms abated significantly over time, and it’s now never an issue. Good luck.

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Originally Posted by kootenayskier

Not exactly the same, but I ripped my calf off in a tree falling incident about 20 years ago, which required major surgery including an arterial graft, and left me with venous insufficiency. I needed to wear compression socks pretty constantly for a few years, and still do when skiing (not because I need to, but because it’s an easy option with lots of great choices) and for flights and long drives. I lead a very active life (might be different if I had a desk job), and found the symptoms abated significantly over time, and it’s now never an issue. Good luck.

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Awesome, thanks for your perspective.

I'm a vascular surgeon--retired. Fixing these kinds of problems is what I did. You could probably keep control of the situation by wearing a compression stocking indefinitely. However, over time the skin in the area will be increasingly damaged and you will be increasingly prone to get more ulcers. Given how young you are I think it would be a good idea to have it taken care of now. The surgery can be done with radiofrequency or laser--either way the idea is to obliterate the vein with the bad valve. 10K seems high but I don't know the costs of things in the fee for service world so maybe it's a good deal. Shop around, see if you can negotiate. This is the sort of operation that can often be done in a clinic rather than a surgery center or hospital and without any sedation--just local anesthetic. It would be best not to wait for things to get worse if you can afford to do it now.

The good news is that it's just the superficial vein--hopefully the US was right about this. When the perforating veins that connect the deep veins to the veins under the skin have bad valves the surgery is a lot more involved.

What Kooetenay described is a much different situation. In his case the venous insufficiency was most likely due to veins blocked by the initial injury and surgical repair, and in time new veins developed. In your case the problem is due to a bad valve in an open vein, not the kind of thing that goes away on its own.

Got it, the cost is also partly due to additional removal of veins on the top of the foot that now have significant varicosities (the doctor reccomended), and due to the fact that this clinic is located in Bozeman, so I believe the rural nature of it increases the cost.

The lab report says: Deep venous insufficiency noted within the superficial femoral vein and popliteal vein. It was definitely clear that this is a very easy outpatient proceedure using Laser ablation. I think really all i need to do is shop around a bit. Thanks for pushing me in the right direction, I was hoping this would just clear up...

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Originally Posted by stoepstyle

Got it, the cost is also partly due to additional removal of veins on the top of the foot that now have significant varicosities (the doctor reccomended), and due to the fact that this clinic is located in Bozeman, so I believe the rural nature of it increases the cost.

The lab report says: Deep venous insufficiency noted within the superficial femoral vein and popliteal vein. It was definitely clear that this is a very easy outpatient proceedure using Laser ablation. I think really all i need to do is shop around a bit. Thanks for pushing me in the right direction, I was hoping this would just clear up...

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Whoa. Is there more to the report. When you said vein near the skin I assumed you were talking about the greater saphenous vein. That's a vein that is often removed to use as a bypass for blocked arteries, like in the heart. We can do without it and it often has failed valves. Did the report say anything about the saphenous vein? Maybe that was also in the report and that is the vein they're planning to ablate.

Despite the name the superficial femoral vein is not close to the skin. It is the main vein from the leg below the knee. (The deep femoral vein is the main vein from the thigh). One would not ordinarily ablate the superficial femoral vein--doing so would restrict blood flow from the leg and lead to swelling and other problems.

You'd better ask some questions and get some clarification.

TECHNIQUE: Greyscale, color doppler and spectral doppler ultrasound images of the deep and superficial venous systems of the right lower extremity was obtained, with augmentation maneuvers. Examination performed with the patient in the reverse Trendelenburg position.

FINDINGS:
Right lower extremity:
Deep system: No echogenic thrombus found within the common femoral, superficial femoral, or popliteal veins. Normal compressibility, color flow, augmentation and/or respiratory variation is demonstrated. Deep venous insufficiency noted within the superficial femoral vein and popliteal vein.

Superficial system: Insufficiency noted from the saphenofemoral junction through the lower thigh GSV as well as within an accessory saphenous vein..
Vein diameters range from 6 mm at the mid thigh GSV to 8.5 mm at the lower thigh GSV.

Perforators: Perforators identified, please see sonographer worksheet.

Varicosities: Varicosities identified, please see sonographer worksheet.

IMPRESSION:
1. No deep venous thrombus identified.Right-sided deep venous insufficiency.

2. Right-sided superficial venous insufficiency.

Insufficiency is determined by reversal of flow for greater than 500 ms.

I appreciate the time taken to look at this. Obviously I will ask for some further clarification

OK, that's makes sense. I would go back to my first recommendation. Have the saphenous veins ablated if you can manage it. I don't know how significant the insufficiency in the superficial femoral vein and popliteal vein is--probably not that significant. They won't be talking about doing anything to those veins, although it's possible you may need to wear a compression stocking indefinitely if you continue to have swelling. Good luck with the procedure if it happens, and don't be afraid to shop around and bargain on price. And if and when you can get better insurance, because this is the sort of problem that can nickel and dime you (ie 5K-10K) over the years.