Edema (swelling) and Phlebolyphedema

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Leg, calf, foot, or ankle swelling (Edema) is a common sign of varicose veins.

The normal flow of blood in leg veins is against the force of gravity; from the foot to the thigh and then up towards the heart. When veins are stretched and enlarged (become varicose), they are too weak to overcome the force of gravity causing the blood to flow backward and pool in the legs. As the pooling continues throughout the day, the pressure inside the vein walls continues to increase. Eventually, some blood and other fluids can leak out of the vein into the surrounding tissue.

The pooling of blood, increased pressure and subsequent “leakage” causes swelling in the ankles and feet as gravity pulls the fluid down. As leakage continues, swelling can also be noted in the lower calf region and extend to the knee or even the thighs.

Swelling is more noticeable at the end of the day, especially if you have spent much of it sitting or standing still. When you elevate your legs, for example when you are sleeping, gravity is no longer a force working against the flow of the blood in your leg veins hence swelling is reduced. However, when you sit or stand, the swelling recurs. Other factors that can contribute to increased swelling include lifting or straining, pregnancy, heat (such as hot baths or sauna), and hormonal changes (that further relax and stretch the weak veins).

During the initial stages of edema, graduated compression stockings may be enough to diminish the tendency of the veins to stretch and control edema. Over time, patients may notice increasing leg fatigue, swelling, thinning of the skin, and discoloration of the overlying skin. Complications such as painful blood clots in the vein, bleeding from veins close to the skin surface, and nonhealing leg sores may develop. Many patients may also notice unsightly spider and varicose veins (Corona Phlebectatica).

Because of the potentially serious and long-term complications of varicose veins, proper treatment is important, and the best results are obtained before complications have already developed. A Vein Specialist can use a Duplex Ultrasound to check “leaky” varicose veins and treatment options.

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Varicose Vein Treatments are coved by insurance including Medicare and Medicaid

• VEIN DISEASE - OVERVIEW
• Varicose Veins
• Chronic Venous Insufficiency
• Blood Clots
• Spider Veins
• Restless Leg Syndrome
• Edema (swelling)
• Infection / Leg Ulcers
• Neuropathy

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Swelling in the legs can be a sign of poorly functioning veins. When the veins fail, blood that normally flows up toward the heart is pulled down by gravity to pool inside the legs. The backflow, called venous reflux, strains the vein walls and the plasma leaks out into the surrounding space leading to swelling in the feet, ankles, and calves. Leg swelling and associated skin changes are called chronic venous insufficiency (CVI).

Edema is primarily noted at the end of the day that can be improved with leg elevation. Left untreated, the recurrent and persistent accumulation of fluid inside the legs begins to stress the lymphatic system. The lymphatic system works as a safety valve to remove excess fluid from the legs. When both, the venous system and lymphatic systems fail, the condition is known as phlebolymphedema.

Lymphatic vessels carry protein-rich fluid and other macromolecules which leak out into the interstitial space. This can make the edema from CVI even worse. Furthermore, the lymphatic fluid triggers an inflammatory reaction that can cause the skin to become red and warm to touch, severe itching, and fluid leakage. Over time, fibrosis sets in, where some of the soft tissue and skin gets converted to hard “scar-like” tissue. At this stage, the condition is largely irreversible.

Modern treatment options available for diseased veins are safe, effective, and require no downtime. Almost all insurance companies offer coverage for the treatment of symptomatic vein problems. However, we do not have definitive treatments available for the management of lymphedema. Treatment of lymphedema, including phlebolymphedema, involves complete decongestive therapy (CDT) and lifelong conservative therapy. Hence, early diagnosis and treatment of edema offers the best chance for long-term symptom relief and protection against complications.

Lymphedema

Complete Decongestive Therapy (CDT) is the gold standard for lymphedema management and is divided into two phases:

• Phase I – Decongestion to decrease the swelling in the limb to as close to normal as possible with the assistance of a lymphedema therapist.
• Phase II – Maintenance that involves continued care at home.

Please describe your experience with us:

Front Desk staff:

Very attentive.

Ultrasound Technologist:

Very good.

Provider/Doctor/Nurse Practitioner:

Explained everything to me, very good.

Call Center/Patient Service Center:

Very good.

What made you choose us?

Heard from a friend.

What symptoms were you experiencing?

Poor circulation in legs. Varicose veins.

How were you affected by your legs previously? What couldn't you do? How has that changed now?

Had lot of heaviness, hurt at night. Now so much better.

What improvements have you seen in your legs?

A lot. They don't hurt and my circulation seems like it's a lot better.

Additional Comments: What did you appreciate? What makes us different than other medical clinics? What could we have done better to exceed your expectations? What changes would you like to see?

I appreciated the staff, very friendly. The technicians that did Ultrasound were very professional & explained what they were doing. Dr. Gupta did a wonderful procedure on my legs. I am so thankful.