Venous Disease

Venous disease is involves an abnormality (occlusion, stenosis or absence) or dysfunction involving any of the veins in the body. Most people have heard of a DVT (deep venous thrombosis) which is a clot in the deep veins, and is a serious condition that can cause a life-threatening PE (pulmonary embolus) which is a clot in the lungs. There however many other conditions affecting the veins of the body, which can cause a variety of symptoms and conditions which may require treatment. Deep venous disease is a chronic condition when the deep veins of the legs don’t work the way they should, which can lead to debilitating symptoms. This could occur when valves no longer work to push the blood back to the heart, or venous occlusion where the vein becomes blocked often as a result of scarring from a prior DVT. The result of the venous dysfunction or occlusion leads to venous hypertension (pooling of the blood with a high back pressure) which if left untreated over many years causes significant damage to the tissues. This damage can lead to changes in skin colour/ discolouration, swelling or oedema, fibrosis (thickening of tissue) and ulceration. Venous ulcers can be very difficult to treat, are often very painful and may become infected which can be serious and at times life-threatening and may require hospitalisation. May-Thurner syndrome is a condition in which the right illiac artery compresses the left illiac vein at its origin, as it crosses under the artery. Whilst this may be just an anatomical variation in some people and cause no symptoms at all, in some people the compression may lead to significant problems such as DVT, venous hypertension or chronic venous insufficiency which could then lead to significant leg pain and swelling and if left untreated may even progress to venous ulceration. Not all patients with compression detected on imaging suffer from symptomatic May-Thurner syndrome nor benefit from treatment, so it is important to consult with an experienced clinician such as Dr Vivienne Moult. Dr Moult will be able to discuss with you regarding your individual condition and will only recommend surgical intervention (such as a venous stent) if necessary and in your best interest. Disease to the superficial veins results in varicose veins - discussed separately Pelvic Venous Disease/ Pelvic Congestion Syndrome Pelvic congestion syndrome is a complex disorder leading to debilitating pelvic pain which severely impacts the individual’s quality of life. Whilst the majority of pelvic pain is NOT due to pelvic venous disease, remains an important cause for a small amount of people. If you suffer from pelvic pain, it is important to first see your GP and then gynaecologist for a thorough investigation into the cause. If pelvic venous disease is thought to be the cause or your symptoms by your gynaecologist, then you will likely then be referred to a vascular surgeon for an opinion and management. Pelvic venous congestion can occur as a result of reflux of the ovarian or pelvic veins. There are multiple causes that may lead to this happening, which is important to thoroughly investigate and address as part of the management plan. Management options include conservative measures (for minor symptoms), embolisation or coiling to the ovarian vein, and treating any underlying condition. Nutcracker syndrome is a condition in which the left renal vein is compressed under the superior mesenteric artery in the abdomen. This is an anatomical variation found on imaging which in the majority of cases is asymptomatic and does not need to be treated. A small minority of people with this finding will suffer from symptoms as a result of the renal vein compression. This could lead to haematuria (microscopic blood in the urine), or pelvic venous congestion as the flow of blood preferrentially flows through the ovarian vein to the pelvic veins back to the inferior vena cava. Treatment of this condition is complex and may involve endovascular procedures and/ or open surgery. Dr Vivienne Moult can provide a thorough assessment to your situation and answering all of your questions and provide a management/ surgical plan.