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Suggest Treatment For Chronic Venous Insufficiency In Both The Legs
Question: Original Posting:
I have been diagnosed with venous insufficiency of both legs but mainly significant reflux in my left leg. I've always had mild insufficiency but wore very min over the counter compression with no problems. After my pelvic myomectomy in February I developed adenomyosis, and my uterus enlarged. I also had a shot of depo provera. I think the combination made for a perfect storm and caused me to have significant reflex as confirmed by my venous ultrasounds done at the vascular clinic. I know progesterone can cause insufficiency, if so, will my insufficiency go away when depo wears off or has the damage already been done? Is the enlarge uterus causing it or is it part of the problem. Will hysterectomy make venous insufficiency go away? Also I have been taking horse chest nut for my VI. I am noticing that I am getting physically tired and exhausted from my insufficiency. Is this normal. What can I do about the physical fatigue? I got fitted for compression socks and should be here next week. I feel like vascular doctor is not taking my VI serious despite my reflux time. He said I have to wear the socks for a while before he can do any surgery,for insurance reasons, but I'm miserable in the interim. I also have large swelling back of thigh, he said it looked like some varicose on the MRI but was not specific and did not seem overly concerned, said otherwise it looked normal no clots, but this is painful.
I have been diagnosed with venous insufficiency of both legs but mainly significant reflux in my left leg. I've always had mild insufficiency but wore very min over the counter compression with no problems. After my pelvic myomectomy in February I developed adenomyosis, and my uterus enlarged. I also had a shot of depo provera. I think the combination made for a perfect storm and caused me to have significant reflex as confirmed by my venous ultrasounds done at the vascular clinic. I know progesterone can cause insufficiency, if so, will my insufficiency go away when depo wears off or has the damage already been done? Is the enlarge uterus causing it or is it part of the problem. Will hysterectomy make venous insufficiency go away? Also I have been taking horse chest nut for my VI. I am noticing that I am getting physically tired and exhausted from my insufficiency. Is this normal. What can I do about the physical fatigue? I got fitted for compression socks and should be here next week. I feel like vascular doctor is not taking my VI serious despite my reflux time. He said I have to wear the socks for a while before he can do any surgery,for insurance reasons, but I'm miserable in the interim. I also have large swelling back of thigh, he said it looked like some varicose on the MRI but was not specific and did not seem overly concerned, said otherwise it looked normal no clots, but this is painful.
Brief Answer:
Surgery might not help.
Detailed Answer:
Hello, Good to hear from you.
Insufficiency once established does not go away. It can improve over a period of time by development of collaterals and tributaries to drain the blood back.
Enlarged uterus can be an added compression on the draining veins but there is no way to be completely sure of that. If the Venogram shows compression then one can say with certainty that there is association if the Uterus to the venous problem.
Physical tiredness cannot be explained by VI alone.
Varicosities can be managed surgically provided the deep veins are patent and draining well. Otherwise what will happen is that surgically the superficial veins leading to the varicosities will be knocked out and the deep veins will be left with the job of draining the entire blood of the limb. If they are also refluxing then the problem will increase as they will be overloaded. Therefore before surgically addressing the Varicose veins it should be established that the deep veins are normal and not refluxing. Surgery should not be done till such time.
We manage such patients with Compression stocking, limb elevation and Tab Daflon 1gm once a day for three months.
Take care and do let me know if there are any other queries.
Regards,
Dr Rishi.
Surgery might not help.
Detailed Answer:
Hello, Good to hear from you.
Insufficiency once established does not go away. It can improve over a period of time by development of collaterals and tributaries to drain the blood back.
Enlarged uterus can be an added compression on the draining veins but there is no way to be completely sure of that. If the Venogram shows compression then one can say with certainty that there is association if the Uterus to the venous problem.
Physical tiredness cannot be explained by VI alone.
Varicosities can be managed surgically provided the deep veins are patent and draining well. Otherwise what will happen is that surgically the superficial veins leading to the varicosities will be knocked out and the deep veins will be left with the job of draining the entire blood of the limb. If they are also refluxing then the problem will increase as they will be overloaded. Therefore before surgically addressing the Varicose veins it should be established that the deep veins are normal and not refluxing. Surgery should not be done till such time.
We manage such patients with Compression stocking, limb elevation and Tab Daflon 1gm once a day for three months.
Take care and do let me know if there are any other queries.
Regards,
Dr Rishi.
Above answer was peer-reviewed by :
Dr. REMY KOSHY
I sent you my images but you have not said anything about this. Also, I was under the impression that resolution of superficial insufficiency can help deep insufficiency. What is it that you are able to conclude from the report and images I have sent to you?
Brief Answer:
The Radiologists report would be helpful.
Detailed Answer:
Hello,
Thanks for your answer.
It is difficult to decipher on the images as to the level of insufficiency.
It would be more helpful if you could send me the report given by the Radiologist as to the presence and grade of superficial and deep vein insufficiency.
Resolution of superficial insufficiency can worsen deep insufficiency, specially if there is obstruction to the outflow of the deep venous system. Resolution of superficial insufficiency can help deep venous insufficiency when the superficial problem is great and the deep problem component is minimal along with no obstruction to the deep venous outflow.
But in a limb with no deep insufficiency and only superficial insufficiency, resolution of superficial component would help greatly.
Therefore, superficial varicosity ablation should be done only after ruling out deep venous obstruction.
Take care and do let me know your queries on this issue.
Dr Rishi.
The Radiologists report would be helpful.
Detailed Answer:
Hello,
Thanks for your answer.
It is difficult to decipher on the images as to the level of insufficiency.
It would be more helpful if you could send me the report given by the Radiologist as to the presence and grade of superficial and deep vein insufficiency.
Resolution of superficial insufficiency can worsen deep insufficiency, specially if there is obstruction to the outflow of the deep venous system. Resolution of superficial insufficiency can help deep venous insufficiency when the superficial problem is great and the deep problem component is minimal along with no obstruction to the deep venous outflow.
But in a limb with no deep insufficiency and only superficial insufficiency, resolution of superficial component would help greatly.
Therefore, superficial varicosity ablation should be done only after ruling out deep venous obstruction.
Take care and do let me know your queries on this issue.
Dr Rishi.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for that. I will be sure to understand the severity of my deeper insufficiency before treatment. In the meantime I have been taking Discovering and Horse chestnut. They seem to help but sometime I still have pain. I thought the pain and aches were ok and improving slot been the feeling of reflux but then I was having PMS and the pain and suffering started again. Is it ok to take ibuprofen with the supplements I am talking? Should I worry about developing blood clots with ibuprofen since I already have venous stasis? I will close and review after your response. Thank you.
Brief Answer:
You can take Tramadol for the pain.
Detailed Answer:
Hello,
Thanks for your answer.
Continue the therapy you are on. It can cause pain intermittently. You can take Ibuprofen for the pain but it would be better to take Capsule Tramadol, that would be safer than Ibuprofen.
You need not worry about clot formation. They should not happen as long as you keep a moderately active lifestyle and do not suffer from any injuries.
If there are any issues please do let me know and do believe that you are fine and will be perfect in no time.
Take care.
Wish you a speedy recovery.
Dr Rishi.
You can take Tramadol for the pain.
Detailed Answer:
Hello,
Thanks for your answer.
Continue the therapy you are on. It can cause pain intermittently. You can take Ibuprofen for the pain but it would be better to take Capsule Tramadol, that would be safer than Ibuprofen.
You need not worry about clot formation. They should not happen as long as you keep a moderately active lifestyle and do not suffer from any injuries.
If there are any issues please do let me know and do believe that you are fine and will be perfect in no time.
Take care.
Wish you a speedy recovery.
Dr Rishi.
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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