Medical Management and Treatment of Venous Disorders
The presence of venous insufficiency without thrombotic complications can initially be treated very conservatively:
- Leg elevation
- Compression stockings
- Scrupulous management of any ulcerations
Leg elevation prevents up to 40% of blood volume to pool in the leg’s veins. Compression stockings keep fragile veins at minimal diameter, reducing the amount of blood retained in them. Mobility helps re-establish the compression/decompression of leg muscles that act as a pump for upward propelling of blood back to the heart.
If there are ulcers, management and treatment involve cultures to identify or rule out infections that can be treated with antibiotics and debridement of any necrotic tissue that can jeopardize adjacent tissue and promote spread of the ulceration. Proper dressing is required to keep the ulcer bed moist for its best healing prospects.
Invasive Management and Treatment of Venous Insufficiency
When medical management fails, addressing the veins directly may be indicated by ablating (destroying) them chemically with sclerosing agents or surgically removing them. Vein destruction or removal reduces the amount of blood in the failing venous system, which helps prevent progression of varicosities and other chronic venous disease.
Management and Treatment of Thrombosis
Thrombosis (clot formation) is a much more serious development. It can cause venous disease or be a result of it. Regardless, thrombi represent imminent dangers:
- Obstruction to venous flow
- Risk of separation and migration to the lung circulation. Resulting in dyspnea or death from pulmonary emboli, or right ventricular disease (“cor pulmonale“) which is heart disease due to pathological lung conditions
Thrombosis requires anticoagulation, using anticoagulants such as warfarin or clopidogrel (Plavix); in thrombosis of crucial venous channels that risk organ damage, surgery or interventional catheterization techniques may be required in conjunction with reversing any therapeutic anticoagulation beforehand. If emboli are frequent and originating from deep vein thrombosis (DVT) in the legs, a filter can be placed in the vena cava as a weir to prevent life-threatening pulmonary emboli.