leg vein treatment

 Leg Vein Occlusions/ treatment 
 

Occlusions in the leg veins are also known as peripheral vascular disease. Depending on the location of the obstruction, the number, the length of the obstructed vein, and the acute (sudden) or chronic (slower) development of obstruction, there may be no symptoms in the patient, and problems may occur up to the leg gangrene.

Anatomy: Clean blood pumped from our heart is sent to the leg arteries through the aorta artery. The limb arteries are divided into 3 regions:

Iliac veins: These are the main arteries of our legs, which are located in the region extending from the upper part of the torso to the upper part of the torso. Blockages in this area usually depend on excessive smoking. The obstruction of this area leads to more leg pain that begins with walking and starts from the hips.

Anatomy of the leg arteries
Anatomy of the leg arteries
Femoral and popliteal vessels: These are arteries located in the area from the two cages to the string. There are two main branches as deep and superficial femoral, with superficial femoral vessels continuing with popliteal vessels at knee level. It is the region where leg vein occlusions occur the most. Most superficial femoral artery obstruction. The obstruction of this area leads to leg pain which is more felt on the thighs and under the thigh than walking on the road.

Crural vessels: There are 3 arteries between each knee and foot. It is the veins in this region that are the most blocked in diabetic patients. Blockages in this area can lead to walking pain under the knee, as well as restfulness and soreness on the toes.

Clinical manifestations: Occlusions in the leg veins can sometimes cause no complaints in the patient. This can be seen if the obstructions are less than 50% of the diameter of the vessel, or if the collateral vessels produced by the body are sufficient, despite severe obstruction in the patient, not in the main vein, but in the side branches. Apart from that, leg vein occlusions can form two separate clinical conditions.

Walking pain (claudication): It occurs when the neck narrowing is not too severe or the constriction or occlusion slows down, and the collapses are not very insufficient. The amount of blood going to the legs is sufficient when the patient is resting, so the patient does not feel any pain while sitting or lying down. However, when the patient begins to walk, the leg muscles increase in blood requirement and the blood becomes insufficient. This pain usually begins when the patient walks a certain distance, goes to sit and relax. When the patient begins to walk again, the pain resumes in the same way. This typical pain is called "claudication" in the sense of Latin lame.

Critical ischemia: Occurs when the number and severity of obstructions is high or when collapses are inadequate. In these patients, the amount of blood that goes to the liver is very low. This amount has severe leg pain when sitting in bed or lying down because the leg can not even meet the need for resting blood. If not treated urgently, this usually causes a wound or gangrene in the leg.

Clinical manifestations of leg vein occlusion
Clinical manifestations of leg vein occlusion
In general, stenosis or blockages in a single vein, which is located in a single vein and is located in the vessels above the index, leads to walking pain, and stenosis and blockages in more than one vein that are located in more than one vein and located in the crural veins under the index lead to critical ischemia. Critical ischaemia occurs more frequently in patients with diabetes because of the occlusion of the vessels below the knee and lesser collateral development.Occlusions in other vessels: Occlusion of the leg veins in one person indicates atherosclerosis is usually common. Approximately half of such patients have occlusion in the heart vessels and four in the brain vessels, but the patient may be unaware of these obstructions because of the absence of infarction or stroke. Studies conducted in patients with peripheral vein occlusions with peripheral arterial occlusions have shown that the mortality rate in these patients is about 4 times higher and that this increase is due to a very large degree of cardiac and cerebral vascular occlusions. Therefore, in all patients who are diagnosed with peripheral vascular disease, drug treatment against common atherosclerosis should be given, the patient should lose weight and leave the cigarette, and the heart and brain vessels should be examined. Because in some of these cases, it may be necessary to intervene in the heart or brain vessels before the leg veins.

Diagnosis, imaging: Peripheral vascular disease can be detected in many patients with a simple heart rate monitor. However, in some patients, the pulsatile examination is insufficient and can be diagnosed easily by measuring the ankle arm index (ABI) in these patients. Below ABI 0.9, it can be said that there is a serious stenosis or blockage in the leg veins. The lower the ABI, the more severe the peripheral vascular disease; In patients with claudication ABI is usually around 0.5-0.9, but falls below 0.5 in critical leg ischemia.

Pulse examination and ABI measurement in peripheral vascular disease
Pulse examination and ABI measurement in peripheral vascular disease
Once the peripheral vascular disease is diagnosed, it is followed by radiological imaging of the stenosis or occlusions. With these methods, it is possible to distinguish whether obstruction is constriction or complete obstruction, the grade of obstacle is determined, the number of obstructions, lengths and locations are determined. After all this information is evaluated together with the clinical findings of the patient, it is decided which treatment method will be applied to the patient.

Additional vessel occlusions in peripheral vascular disease
Additional vessel occlusions in peripheral vascular disease
Imaging of occlusions in the heart and brain vessels is also important in peripheral vascular disease. In addition to cardiologic and neurological examination, tomography angiography of the heart and brain vessels can be performed in these patients, if necessary by multislice CT and intravenous drug administration. Ultrasonography can also be used to examine the vessel vessels and the aorta of the abdominal cavity in terms of obstruction and aneurysm (ballooning).

Treatment: Peripheral vascular disease, ie leg vein occlusion, treatment should be conducted in two ways. On the one hand, patients with leg artery occlusion should be treated with appropriate methods while fighting widespread atherosclerosis and additional cardiac and cerebral vascular occlusions should be investigated and treated if necessary.

Treatment of leg vein occlusions: There are three valid methods for resolving complaints related to vascular occlusion: 1. Drug and exercise therapy, 2. Endovascular treatment. 3. Surgical operation. Drug and exercise therapy is usually applied in cases that are not complaints and have been detected incidentally or with mild complaints. Endovascular or surgical treatment is preferred in those with obvious complaints. In the past, surgical treatment was much more common, but nowadays it has left its place largely endovascular treatment. The most commonly used method for endovascular treatment is angioplasty with balloon or stent.

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Treatment options for leg vein occlusion
Treatment options for leg vein occlusion
The most important criteria that determine how to treat a blockage is the placement and length of the blockage. In general, very long obstructions are treated with surgery and shorter ones are treated with angioplasty. Currently, it is recommended to treat obstructions of up to 15 cm in length with angioplasty (TASC 2007). Surgery should be considered for longer occlusions. The settlement of the obstruction is also important. It is often problematic to place a stent in a moving area, such as the hip and knee joint. Surgery should be preferred primarily in these areas of congestion. Another factor affecting the choice of treatment is the clinical condition of the patient. Surgical operation may be risky in some patients due to heart and lung disturbances associated with leg blockages. In these patients, angioplasty can be tried. In some cases, some of the patient's obstructions may need to be treated surgically, and some of them may be treated with angioplasty. Whenever possible, a vascular surgeon and an interventional radiologist should be consulted about which method to choose for peripheral vascular disease.Stenting iliac vein occlusion in a patient
Stenting iliac vein occlusion in a patient
Common atherosclerosis therapy: Cardiac and cerebral vessels are frequently involved in peripheral vascular disease and these patients should be actively treated with systemic atherosclerosis. Nowadays, a person who is diagnosed with peripheral vascular disease is treated as a patient who has had an infarction or stroke. Risk factors such as hypertension, diabetes, and elevated cholesterol levels are first investigated in these patients and drug treatment is started immediately if necessary. It is recommended that cholesterol be given even if cholesterol is normal in peripheral vascular patients. Good treatment of hypertension and diabetes is also very important to slow the progression of peripheral vascular disease. Since atherosclerotic plaques can trigger clotting, almost all of these patients are given blood thinners. It is tried to ensure that the patients do regular sports, lose weight and stay away from cigarettes. Cardiologic and neurological evaluation should be performed, and if necessary, the heart, neck and brain vessels should be visualized. A congestion in these veins may be even more important in some cases,you may need to be treated before the blockage.