Chronic Venous Insufficiency With Emphasis on the Geriatric Population
What Are The Risk Factors For Deep Vein Thrombosis?
Several factors can increase a person's risk of deep vein thrombosis (DVT) development. Examples include injury to the veins, hormonal changes, reduced blood flow, certain health conditions, and more.
DVT is a blood clot that occurs in a vein deep within the body, typically in the leg. DVT risk factors may be transient, or temporary, such as pregnancy or recovering from surgery. They can also be persistent, such as cancer or living with a chronic health condition.
Knowing a person's risk factor for DVT can help healthcare professionals identify and treat DVT faster if it occurs. It can also allow a person to take steps to help reduce their risk.
This article reviews the various risk factors for DVT and discusses prevention tips, when to contact a doctor, and more.
Injury to veins can increase the risk of a person developing DVT. Some causes of vein injury include:
Hormone changes can influence the risk a person has for developing DVT. In particular, an increase in estrogen can increase a person's risk of DVT.
Some causes of estrogen increase include:
Reduced blood flow can increase the risk of DVT development.
Inactivity may cause reduced blood flow in several people. Factors that can result in inactivity and increase the risk include:
Wearing a cast following an injury may also reduce blood flow.
Certain medical conditions and infections can increase the risk of DVT.
Some chronic conditions that may increase a person's risk include:
Infections such as sepsis and COVID-19 may also increase a person's risk of DVT.
Other factors can contribute to DVT risk. They include:
A person can inherit some risk factors for DVT.
The identified inherited clotting disorders that can increase the risk of DVT include:
Having a non-O blood group and a family history of DVT or pulmonary embolism increases the risk of DVT.
The exact number of people who develop DVT is unclear. Estimates suggest that about 900,000 people will develop venous thromboembolism — either DVT or a pulmonary embolism — each year in the United States.
Approximately 60,000–100,000 people will die due to venous thromboembolism each year.
Knowing the risk factors and taking steps to reduce these can help a person reduce the likelihood of developing DVT.
A person may be able to take steps to reduce the likelihood of developing DVT.
Steps a person can take to help reduce their risk include:
Wearing graduated compression stockings may also help reduce the risk of DVT. A doctor can advise on what class of compression stockings a person should wear and for how long they should wear them.
A person should contact a doctor if they develop symptoms that could indicate DVT. These include:
A person can also contact their doctor for advice if they have concerns about the risk factors for DVT. Their doctor can assess their risk and advise on steps they can take to reduce the likelihood of developing the condition.
The doctor can also advise on suitable treatments for DVT. Treating DVT can help reduce the risk of pulmonary embolism, which can be fatal in some cases.
Learn more about the symptoms of DVT.
Deep vein thrombosis (DVT) has several potential risk factors. They include injury to veins, chronic health conditions, infections, surgery, and trauma. Other factors that may increase the likelihood of developing DVT include hormone changes, obesity, smoking, and being over the age of 40 years.
A person can contact their doctor for advice if they have concerns about the risk factors for DVT. The doctor can recommend lifestyle changes to help manage the risk. In some cases, they may also recommend medications such as anticoagulants.
People should also contact a doctor if they develop symptoms of DVT, such as pain or tenderness, swelling, or feeling of firm veins.
All You Need To Know About Thread Veins
by JEAN WILLIAMS, Mail on Sunday
Read our comprehensive guide to thread veins and how to treat them, and you can chat to other sufferers on our message boards by clicking on the link in the box below.
Summer's coming and if the thought of shedding trousers and showing your
legs fills you with dread, take heart. There are treatments that can dramatically improve the appearance of unsightly thread veins.
What are thread veins? Thread veins are tiny blood vessels which run close to the surface of
the skin and look like fine red, or sometimes purple, wiggly lines. They're also sometimes called 'spider veins' or 'broken veins', although the veins aren't infact broken but only slightly enlarged. The medical term for them is telangiectasia.
What causes them? Usually there's no obvious cause. Thread veins tend to develop as we age and our skin and blood vessels become less elastic. Hormonal changes associated with pregnancy and the menopause are thought to provoke their development - the reason why women are more prone to them than men.
You can also inherit a family tendency to the problem. Other causes include too much sunbathing, exposure to wind or extreme temperatures, cortico-steroid medicines and radiotherapy. Jobs that involve prolonged standing may aggravate the condition, but they don't actually cause it. Although you may not like the look of them, thread veins aren't dangerous, but they tend to become larger and increase in number over time.
Who gets them? Nearly all of us as we age, apparently. Around one in five women in their 20s have thread veins, a figure that rises to around half by the age of forty and continues to increase. By the age of 70 over 70 per cent of women have some thread veins.
Dr John Cotterill, consultant dermatologist and medical Director of Lasercare Clinics advises treatment sooner rather than later. 'Smaller thread veins are easy to treat. Later on they can be more difficult. Younger women could save themselves a great deal of time, trouble and expense if they opted for early treatment.'
How are they treated? There are several options, lasertherapy, sclerotherapy or a mixture of both. Electrolysis is also used but this is far less popular now that laser treatment is widely available. Lasertherapy uses brief pulses of laser light to destroy smaller blood vessels. Several types of laser are used. A pulsed dye laser is best for thin red veins which are close to the skin's surface. Deeper blue or purple veins need a laser with a longer wavelength (YAG laser) to reach them.
Veins bigger than 4mm require sclerotherapy. This treatment uses a tiny needle (smaller than a sewing needle) to inject a solution (scelerosant) that causes microscopic damage to the cells lining the vein. The vein gradually shrinks and disappears over a period of about eight weeks. At an initial consultation your veins will be assessed and you'll be advised which form of treatment is most appropriate for you. Normally a test patch will be done at the same time.
Is the treatment painful? It shouldn't be. Although laser destroys tissue by heat you won't feel any burning or pain. Each pulse is less than a thousandth of a second and the laser only works on the unwanted vein leaving other skin untouched. The sensation of a laser is often described as similar to a rubber band pinging against your skin. A local anaesthetic cream can be used if you wish.
With sclerotherapy you'll notice the pricking sensation of the needle. Normally a local anaesthetic is injected into the vein with the sclerosant solution so the pain is minimal. Treatments normally last for around 20 to 30 minutes.
Are there any after effects? With sclerotherapy the veins may appear worse immediately after treatment and the site of the injections can look rather like insect bites. There may also be some bruising and sometimes the treated area may itch a bit. After a week or so the veins should begin to fade and they'll continue to do so for up to eight weeks, or even longer for bigger veins.
How many treatments are needed? On average three, but more may be necessary, depending on the number of veins and their size and location. The normal procedure is to tackle the larger veins first with sclerotherapy and then clear up the smaller ones with laser treatment. Treatments are spaced about eight weeks apart, so it may take more than six months to achieve the final result. Start now if you want better looking legs this summer.
How successful is it? You need to have realistic expectations. 'Some thread veins can be quite difficult to treat because they don't always run obligingly parallel to the skin surface,' says Dr Cotterill. 'Some are like big dippers they go up and down and a laser light doesn't always reach deeply enough to destroy them.' Veins in the lower part of the leg, particularly the ankle area, are more difficult to treat than those on the thighs. It's not normally possible to get rid of all the veins, but around 90 per cent clearance is common.
Are there any risks or side effects? Complications are unusual, but occasionally a skin ulcer can develop after sclerotherapy and some patients experience a brown discolouration of the skin which may take several months to fade away. Around 10 per cent of people treated get 'matting' after sclerotherapy - a cluster of tiny red vessels around the treated area. However these can normally be cleared by laser treatment later. A very rare complication is the development of a blood clot in the vein (deep vein thrombosis).
Are thread veins related to varicose veins? They are part of the same spectrum of problems caused by blood pressure in the superficial veins of the legs being too high (see box below). If you have varicose veins you are more likely to have thread veins too, but the reverse isn't true, having thread veins doesn't predispose you to varicose veins. 'In women with big varicose veins there's no point treating thread veins until the varicose veins have been sorted out,' says Dr Cotterill. 'They need doing first otherwise the treatment for thread veins won't work.'
What about treatment for broken veins on the face? Laser can treat the very fine veins that can appear on the nose, cheeks and chin and it's usually very successful. Often thread veins on the face are part of a condition called rosacea and additionally medication may be needed to control the problem.
Where is the treatment available? There are scores of clinics offering laser treatment around the country. The drawback is that anyone who can afford to buy a laser and pass a local authority hygiene inspection can operate most types of laser. They don't need to be medically qualified, so beware! 'You need to check that the person who is actually going to treat you is medically qualified, and is preferably a dermatologist or plastic surgeon, ' says Doreen Trust, of the Disfigurement Guidance Centre.
The charity publishes The Skin Laser Directory which lists reputable UK clinics, both private and NHS, with details of their medically qualified staff. 'Even if you are paying privately my advice is to ask your GP for a referral,' says Mrs Trust, 'because he or she acts as a safeguard. If you've been referred the clinic will write to your GP after treatment with details of what's been done and the outcome, so you have a record, should there be any later problems.'
What does it cost? Costs vary widely. The largest group of 12 clinics, Lasercare, which operate both privately, and in the NHS charge £230 for a consultation and first treatment, then £185 per session afterwards. 'It's a good idea to select three or four clinics and call them,' says Doreen Trust. 'Describe your condition and ask how many treatments roughly will be needed what the approximate total cost of the treatment will be. It can vary widely so it's worth checking a few out.'
Is the treatment available on the NHS? Cosmetic surgery is normally only NHS funded if your appearance is having a detrimental effect on your mental health, for example if it's causing you to be depressed, or affecting your career or family relationships.
Treating varicose veins: Varicose veins are very common and affect around one third of women. The problem is part and parcel of the same circulatory disorder as thread veins, but at the more severe end of the scale. Varicose veins can become very painful and lead to complications such as bleeding, swelling and ulceration. They develop when the walls of the veins and the valves inside them sag under the pressure of the blood they carry. The veins dilate and the valves, which should help move the blood upwards, together with the action of the calf muscles, no longer work efficiently.
Treatment for varicose veins isn't always very successful. Around 100,000 NHS operations are performed each year and about 20 per cent of these are repeat surgery for recurrence. Small varicose veins are sometimes treated with sclerotherapy, in the same way as thread veins. However veins treated in this way are most likely to recur, and normally surgery is the preferred option.
There are two main methods. Either the varicose vein is disconnected and 'tied off' so that the blood is diverted through healthier veins. Alternatively, if the vein is very large and distended, it may be removed altogether through an incision in the groin, a process known as 'stripping'. Although it sounds alarming, the surgery is normally done as an outpatient and recovery takes only a matter of days.
A new procedure called VNUS closure has also recently been introduced here. A catheter is threaded into the vein, to introduce heat, which collapses and seals it. The treated vein becomes scar tissue and is eventually re-absorbed. The procedure costs around £2,500 a leg and involves an incision made into the knee or ankle rather than the groin. Because the procedure is so new it's not yet known how effective it might be at preventing recurrence long term, for example over five years.
Find out more: Lasercare - Tel: 0800 0287222
The Skinlaser Directory £5 inc p&p is available from POD Publications,
P.O.Box 7, Cupar, Fife KY15 4PF
See www.Veins.Co.Uk for information on VNUS closure
Spider Veins And Varicose Veins – Not Just A Cosmetic Problem
Sponsored By:
OVER 50 PERCENT of the American adult population suffers from some sort of vein problem with their legs. If you have immediate family members who have had varicose veins or spider veins then the odds go up even further. Some of us who have a very strong family history have an 80-90 percent likelihood that we will suffer from venous disease at some point in our lifetime. Vein problems do seem to be more prevalent in women but we see varicose veins and significant venous reflux in men all of the time. In general, although men are a little less concerned about the cosmetic issues than women, their symptoms and findings certainly warrant evaluation and intervention when indicated just the same.
Many people consider spider veins and varicose veins a cosmetic inconvenience only. Nothing could be further from the truth! Most people that we see that have these findings have them for a reason. That reason is something that we call superficial venous reflux disease. Superficial venous reflux is a disease process that affects the hundreds of little one-way valves that are normally seen in the leg veins. The presence in leg veins of one-way valves is the thing that assures that blood travels upward, against gravity and back toward the heart. Genetics, pregnancies and several other things may work together to make leg veins dilate with time. As the vein dilates, the one-way valves no longer function properly and blood actually starts flowing downward, in the wrong direction. This downward flow of blood leads to pooling and increased pressure throughout the venous system of each leg. The constant increase in pressure is then transmitted outward, more superficially and that is what leads to the dilatation of the more superficial venous vessels that we then see on our skin. The dilated superficial veins we see are spider veins and varicose veins. This constant downward pressure can also lead to more serious changes such as skin discoloration that becomes permanent, drying and rash formation and even chronic ulceration that can lead to infection and gangrene.
Spider veins and varicose veins are just the tip of the iceberg. The real problem often times lies beneath the surface of the skin and away from our visual scrutiny. So, spider veins and varicose veins are not just a cosmetic problem and if one suffers from these findings it's best to be evaluated fully by a board certified vascular surgeon who specializes in vein care. The good news is that modern day vein care is nearly painless and can be accomplished fully with in-office, minimally invasive procedures that result in no down time and can be nearly 100 percent effective.
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