New research published in the New England Journal of Medicine shows that the respiratory virus SARS-CoV-2, which causes COVID-19, is also responsible for severe damage to blood vessels increasing the risk of blood clots. One Amsterdam study found that almost one-third of patients hospitalized with severe COVID-19 demonstrated complications from blood clots.

A blood clot is a clump of blood formed when blood changes from a liquid to a thicker gel-like state. Ordinarily, this can be a life-saving mechanism to help stop bleeding; however, when the clot breaks off, it can travel through the bloodstream choking the supply of blood to essential organs such as the lungs (causing a Pulmonary Embolism) or the brain (causing a stroke).

Patients admitted to the hospital are more likely to have blood clots in the blood vessels of the legs due to immobility while hospitalized. Staying active, use of compression stockings, sequential compression devices, and, in select cases, the use of blood thinner can help lower the risk of clots.

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COVID-19 Blood Clots

There are also reports of blood clots in patients with COVID-19 who are at home and staying active. Swelling in the legs is the most common sign of blood clots. Some patients with COVID-19 develop a condition called “Covid toes” – red, swollen toes that may be due to small clots in the blood vessels of the feet.

If you have leg swelling, pain in the legs, or any other sign of a blood clot, please call us at 816-396-0245 to have a duplex ultrasound screening test for blood clots. This is performed in the comfort of the office setting at Alsara Vein Clinic.

President Donald Trump was recently diagnosed with Chronic Venous Insufficiency (CVI). His diagnosis has sparked renewed interest in this common yet often overlooked condition. Many patients are now asking important questions: What is CVI? Is it serious? Who gets it? How is it treated? Let’s dive right in.

What is CVI?

Chronic Venous Insufficiency (CVI) is a medical condition in which the veins in the legs don’t function properly, making it difficult to pump blood back to the heart. This leads to circulation problems and a variety of leg symptoms.

In the early stages, symptoms may be subtle such as heaviness, fatigue, aching, throbbing, itching, or burning in the legs. As the condition progresses, due to inadequate blood flow to calf muscles patients may experience leg cramps (often called “Charley horses”) or restlessness at night (Restless Leg Syndrome).

Without treatment, CVI can worsen and lead to leg swelling, skin discoloration, bleeding varicose veins, recurrent skin infections, blood clots and poorly healing sores (ulcers)

How Common is CVI?

CVI is extremely common, affecting 10–35% of adults in the U.S. Both men and women are at risk, but women often develop symptoms earlier due to pregnancies and hormonal changes. In fact, nearly 40% of women over age 50 have some degree of CVI.

Risk factors include family history of vein disease, age and prolonged standing or sitting

Treatment of CVI

In the past, treatment for CVI often required invasive vein stripping surgery in a hospital, followed by a long and painful recovery. Thankfully, modern medicine has transformed vein care.

Today, CVI can be treated in the comfort of an office setting with minimally invasive procedures. Diseased veins are safely closed, restoring healthy circulation. Patients typically return to normal activities immediately with no downtime, and minimal discomfort. Many notice improvements in their legs as soon as the next day.

A quick, painless duplex ultrasound can diagnose CVI, and your vein specialist will review personalized treatment options. Almost all insurance plans including Medicare cover treatment of symptomatic vein disease.

Call Alsara Vein Clinic today at 816-396-0245 for a Consultation. We offer same-day appointments.

Many patients now recognize that varicose veins may not be visible from the outside. Most of our patients report experiencing tiredness, cramping (charley horse), restlessness, or swelling in the legs. Those whose condition has not reached one of the advanced stages often wonder if they are at increased risk of anything that could be limb or life-threatening.

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At least one-third of our patients clearly have signs of advanced venous insufficiency – when varicose veins have progressed to a point where the chronic pooling of blood (stasis) in the legs causes skin changes. They may notice skin discoloration, thickening or hardening of the skin, recurrent skin infections, bleeding that can be profuse, and poorly healing sores in the legs. In addition, varicose veins may be an early warning sign of potentially deadly blood clots.

We routinely see patients with blood clots. Some are referred by their primary care providers and others present themselves with concerns about blood clots. Yet there are many patients who are surprised to find that they have a blood clot when we examine them using duplex ultrasound.

Introduction

Restless Leg Syndrome (RLS) is characterized by an irresistible urge to move the legs to alleviate discomfort, ranging from aching and throbbing to itching and crawling sensations.² Articulating these sensations can be challenging for some patients.

Who gets it?

Initially documented in 1945, RLS, also known as Willis-Ekbom disease³, was reported to affect around 5% of the population. Recent studies, however, indicate a prevalence ranging from 3% to 15%. It tends to occur more frequently in women, with a nearly 2:1 female-to-male ratio. As age advances, there is a positive correlation with RLS prevalence. Genetics plays a role, as up to 25% of first-degree relatives of individuals with RLS report similar symptoms.⁴

Connecting Varicose Veins and RLS

Even in the 1940s, when Restless Leg Syndrome (RLS) was first identified, Dr. Ekbom suggested that venous disease could be a potential cause. However, it took around fifty years to firmly establish this connection. A groundbreaking 1995 study published in the Journal of Dermatologic Surgery treated 113 individuals with restless legs and ultrasound-confirmed vein disease using sclerotherapy.⁵ Surprisingly, 98% of participants reported immediate relief. Subsequent studies have consistently supported this link, uncovering RLS symptoms in individuals with primary and recurrent varicose veins¹. Addressing superficial venous insufficiency has proven effective in alleviating RLS symptoms for most patients. Nonetheless, it's essential to acknowledge that certain conditions, including iron deficiency anemia, pregnancy, kidney failure, various neurological conditions, and specific medications, can also contribute to RLS symptoms.

Explaining the connection

Impaired venous blood return in the legs, particularly in chronic venous insufficiency (CVI), may drive the subconscious urge to move the legs (RLS), forcing you to use your muscles that help pump blood back to the heart. Inflammation associated with CVI could lead to overactive nerves, intensifying the situation. Nighttime leg cramps and pain, often linked to varicose veins, can further disrupt sleep, aggravating leg restlessness.

Determining if Varicose Veins might be responsible for Restless Legs

A straightforward and noninvasive duplex ultrasound in your Vein Specialist’s office can identify any underlying venous issues. The Vein Specialist will review a treatment strategy if venous insufficiency is found. Typically, the affected veins are closed using one of the FDA-approved treatment modalities to reroute blood flow through healthier veins.⁶

Conclusion

Restless Leg Syndrome (RLS) is a common issue often linked to varicose veins. You might also be encountering other symptoms of varicose veins and associated venous insufficiency, including sensations of heaviness, fatigue, aching, cramping, and swelling in the legs. If left untreated, the condition can worsen, leading to potential complications such as blood clots, bleeding, frequent skin infections, and slow-healing sores. Medications for RLS, such as Ropinirole and Pramipexole, may mask the symptoms without addressing the underlying problem. Reach out to Alsara Vein Clinic at 816-396-0245 for a complimentary Consultation.

Take the initial step towards relief and an improved quality of life.

1. Restless legs syndrome symptoms in primary care: a prevalence study. Nichols DA, Allen RP, Grauke JH, et al. Arch Intern Med. 2003;163:2323–2329
2. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology:Sleep Med. 2003;4:101–119. 
3. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria Sleep Med. 2014;15:860–873. [
4. Treatment of Leg Veins for Restless Leg Syndrome: A Retrospective Review, Swaminathan et al, Cureus 2019
5. The effect of sclerotherapy on restless legs syndrome Dermatol Surg 1995 April 21 
6. The effect of endovenous laser ablation on restless legs syndrome Hayes et al Phlebology June 2008

Many patients now recognize that varicose veins may not be visible from the outside. Most of our patients report experiencing tiredness, cramping (charley horse), restlessness, or swelling in the legs. Those whose condition has not reached one of the advanced stages often wonder if they are at increased risk of anything that could be limb or life-threatening.

At least one-third of our patients clearly have signs of advanced venous insufficiency – when varicose veins have progressed to a point where the chronic pooling of blood (stasis) in the legs causes skin changes. They may notice skin discoloration, thickening or hardening of the skin, recurrent skin infections, bleeding that can be profuse, and poorly healing sores in the legs. In addition, varicose veins may be an early warning sign of potentially deadly blood clots.

We routinely see patients with blood clots. Some are referred by their primary care providers and others present themselves with concerns about blood clots. Yet there are many patients who are surprised to find that they have a blood clot when we examine them using duplex ultrasound.

Blood clots are far more common than most people think. Serena Williams and Hillary Clinton are among the dozens of celebrities who have suffered consequences due to blood clots. James “Jimmy” Stewart from the movie It’s a Wonderful Life and NBC journalist David Bloom lost their lives from blood clots. David Bloom’s wife, Melonie Bloom, has devoted her life to raising awareness of thrombosis.

The association between varicose veins and deep vein thrombosis (DVT) was demonstrated in a landmark Taiwanese study published in JAMA (Journal of the American Medical Association). Reviewing the health records of over 425,000 adults, the study found a higher rate of pulmonary embolism (when a blood clot in the leg breaks off and travels to the lung) and peripheral artery disease in patients with varicose veins.

• Varicose veins increase the risk of deep vein thrombosis (DVT) by five times
• DVT is a clot in the legs, which can lead to amputation or even death
• Varicose veins make people twice as likely to develop a pulmonary embolism
• Varicose veins double the risk of peripheral artery disease, which reduces blood flow

Varicose veins are veins with weakened walls that fail and cause pooling of blood in the legs. Patients with varicose veins are known to have increased levels of inflammatory and pro-thrombotic markers. These patients have a considerably high risk of forming blood clots in their legs.

Not all clots are serious, but they often tell us about an underlying problem such as impaired blood flow that can lead to greater problems down the road. As Dr. Chang, the lead author of the Taiwanese study stated, “varicose veins deserve careful monitoring and early evaluation”.

Call us at 816-396-0245. We are here for you.

Because heat dilates the veins, many vein issues worsen during the summertime. With higher temperatures, veins expand leading to more pooling of blood in the legs and problems associated with it such as leg pain, tiredness, leg cramps, swelling (edema) and blood clots. There is also an increased chance of seeing new spider veins.

Here are some tips to help you enjoy the warm season.

1. Stay Cool
   Make sure you wear clothes that won't trap heat. Always use sunblock (SPF 30 or above) not just on your legs, but also on your face and nose, where thinner skin is more prone to developing spider veins.
2. Take a Dive
   In addition to offering great respite from the summer heat, swimming can also promote normal circulation in your legs. Swimming is a low-impact exercise that saves your joints from the pounding, yet increases your heart rate and improves overall circulation. Also, cooling exercises like swimming, surfing, and brisk evening walks help keep the blood vessels from dilating.
3. Stay Hydrated
   Keeping your body properly hydrated will help effectively circulate blood, heal injuries faster, and allow for healthier skin. While the summer heat can easily dry anyone out, patients with vein problems should pay closer attention to their hydration during this time. If you plan on being out of the AC, plan to also bring a water bottle along and avoid caffeine as much as possible.
4. Avoid Heels
   We recommend flats and sandals rather than high heels to help your calf muscles pump blood up from the leg to the heart. Wearing lower heels makes your calves work a little harder ensuring the correct flow of blood.
5. Wear Compression Stockings
   They may not be at the top of anyone’s list for hot summer fashions, but compression stockings put pressure on your legs that helps move blood up and away from your lower legs. Though you may not want to wear them outside during July and August for fear of overheating, wearing them regularly will prevent blood from pooling in your legs, which can cause or worsen vein problems.

Varicose veins and spider veins have ruined too many summers. To keep them from ruining this one, schedule an appointment with a Vein Specialist. Current treatments allow us to permanently treat affected veins with no downtime. Treatment of symptomatic varicose veins is covered by almost all insurances including Medicare and Medicaid.

Life is a beautiful journey. Don't let your legs slow you down.