By Tom Tran PA-C, MPAs, NCCPA Surgery Board Certified –
Venous insufficiency not only causes varicose veins, it can be the underlying cause for a plethora conditions, including lower extremity cellulitis, leg cramps and restless legs syndrome. When patients present with venous insufficiency symptoms, physicians often only check some of the obvious explanations and do not delve deeper to look for the possibility of venous reflux as an underlying cause. Unfortunately, there is a large percentage of people walking around with venous problems who aren’t getting the evaluation or treatment they need.
Relationship of Venous Insufficiency and Restless Legs Syndrome (RLS)
Restless legs syndrome is believed to be associated with a number of factors, including iron deficiency, peripheral neuropathy, Parkinson’s disease and other neurological disorders. Recent medical research reported that a great number of patients with restless legs syndrome also have venous insufficiency as revealed through proper examination.
Symptoms of restless legs syndrome may vary from person to person but often include burning, tingling, creeping sensations and the uncontrollable urge to move the legs, which is generally worse at night when laying down and is usually relieved by movement or walking. The symptoms of venous insufficiency and restless leg syndrome are almost interchangeable and many patients with documented severe superficial venous insufficiency and restless leg syndrome will have resolution of their restless leg syndrome after successful vein treatment.
Studies show that the treatment of venous insufficiency can relieve symptoms of restless leg syndrome. According to a study in the journal Phlebology, in patients with restless leg syndrome and venous insufficiency, 98% of patients experienced relief from restless legs syndrome symptoms by treating their venous insufficiency, and 80% had long-term relief.
Before committing a patient with restless legs syndrome to possible life-long medication with potential side effects, venous insufficiency should be checked as a possible cause, as correction of the vein reflux provides long-term and likely permanent relief.
Obtain a Proper Diagnosis
Correctly diagnosing vein disease involves a review of the patient’s history of symptoms, physical examination and a duplex ultrasound of the veins. It’s important to have the ultrasound performed at a specialized vein center, because their sonographers are trained to detect venous insufficiency and can diagnose it with greater accuracy than general radiography technicians.
Once venous insufficiency has been correctly identified as the cause of restless leg syndrome (or any other problem for that matter), a variety of conservative treatment methods may be utilized as an initial treatment approach. These may include elevating the legs when possible, avoiding long periods of sitting or standing, wearing compression stockings and being active. If these methods are not successful, a variety of surgical or procedural options may be recommended.
Endovenous Laser Ablation Treatment
Vein stripping or vein ligation of the saphenous vein was once the primary method for treatment of varicose veins and its underlying cause. It involves tying off and stripping out the damaged vein. Vein stripping usually requires a recovery period of six weeks or more and can involve significant postoperative pain.
Fortunately, a minimally invasive alternative to surgical stripping of veins is now available, endovenous laser ablation (ELA). Reports indicate that ELA has an outstanding 98% successful rate of alleviating symptoms and very low recurrence rate. Compare this to the 40% recurrence rate of vein stripping and there is no denying which treatment produces better results.
The nonsurgical procedure inserts a small probe with a laser fiber through a freckle-sized nick in the skin. Ultrasound guidance helps direct the probe to the damaged vein. Pulses of laser light are delivered into the vein, causing the internal vein wall to collapse and seal shut. This 45-minute, minimally invasive treatment can be performed in a single office visit with local anesthesia.
Because ELA is so minimally invasive, there is no scarring and the recovery period is nothing compared to vein stripping. Patients are up and walking the same day and can resume normal activities within a day or two.
ELA is the quickest, most effective procedure for venous insufficiency, and as such it provides a great deal of relief for those with concurrent restless leg syndrome and venous insufficiency. Let’s revisit the facts from above, in a recent study after receiving ELA 98% of patients experienced relief from restless legs syndrome symptoms by treating their venous insufficiency, and 80% had long-term relief.
Given the results of the recent studies, it is recommended that, before patients start taking prescription medication for restless leg syndrome, they request a consult by a qualified vein specialist who will likely perform ultrasound evaluation to identify whether there is significant underlying venous insufficiency which may be causing or contributing to their problem. There is no downside to getting an ultrasound; there is no radiation involved, no needles, no pain, and it is a physiologic test which reveals which veins are leaking and how much they are leaking. Venous ultrasound for insufficiency is conservative, noninvasive, and it accurately identifies which patients are most likely to benefit from treatment.
Despite the prevalence of venous insufficiency among those with restless leg syndrome, venous insufficiency is often under recognized and under treated. If you or someone you love have been diagnosed with restless leg syndrome and are currently taking medications to relieve the symptoms, you may only be masking the manifestations of the condition and not treating the underlying cause. If it is determined that your restless legs are a result of venous insufficiency there are non-medication treatments available, like endovenous laser ablation, that can alleviate the unpleasant sensations of your condition.
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