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Suggest Treatment For Venous Insufficiency On Both Legs

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Posted on Fri, 14 Oct 2016
Question: I have been diagnosed with venous insufficiency of both legs but mainly significant reflux in my left leg. I've always had mild insufficiency but wore very min over the counter compression with no problems. After my pelvic myomectomy in February I developed adenomyosis, and my uterus enlarged. I also had a shot of depo provera. I think the combination made for a perfect storm and caused me to have significant reflex as confirmed by my venous ultrasounds done at the vascular clinic. I know progesterone can cause insufficiency, if so, will my insufficiency go away when depo wears off or has the damage already been done? Is the enlarge uterus causing it or is it part of the problem. Will hysterectomy make venous insufficiency go away? Also I have been taking horse chest nut for my VI. I am noticing that I am getting physically tired and exhausted from my insufficiency. Is this normal. What can I do about the physical fatigue? I got fitted for compression socks and should be here next week. I feel like vascular doctor is not taking my VI serious despite my reflux time. He said I have to wear the socks for a while before he can do any surgery,for insurance reasons, but I'm miserable in the interim. I also have large swelling back of thigh, he said it looked like some varicose on the MRI but was not specific and did not seem overly concerned, said otherwise it looked normal no clots, but this is painful.
doctor
Answered by Dr. Rishi (3 hours later)
Brief Answer:
Need to know details about the Reflux.

Detailed Answer:
Hello.
Welcome to Health Care Magic and Thank you for your question.
I am a Vascular Surgeon and will try to help you.
It would be very helpful if you could share your Doppler report with me. I need to know whether you have deep reflux or superficial or both. Superficial reflux can be managed with Laser surgery easily but not Deep reflux.
Deep reflux does not completely go away.
The Uterus can be a cause and removal might help if any imaging proves Venous compression by the Uterus
Physical tiredness and exhaustion can't be explained by CVI.
The myomectomy surgery was done by Laparoscopy or Open?
Tight compression stockings are a must and you should also start having Tab Daflon 500mg twice a day. This will help the Venous Reflux.
Do let me know the answers to above questions and your reports as well.
Take care and do not worry.
Look forward to hearing from you.
Regards
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rishi (19 hours later)
Hello Dr. Thank you. I have both superficial and deep insufficiency. I was told that the superficial was likely the cause of the deep insufficiency and would likely improve once superficial veins were treated. Problem is mostly in left leg. Right leg has some minor insufficiency comparatively. Other problems are I was told that lump on back of thigh was edemas or lymphedema associated with varicose veins and some perforating veins. I was told several veins have reflux times of greater .5 sec and some as much as 6 sec.

I told my vascular surgeon that I could not wait 3 months for surgery because the reflux, pain and suffering is so bad. I also have a lot of muscle twitching in just my legs? What could be the cause of this? I think he said the varicose veins and reflux was mostly in my left thigh where the large lump and swelling is located. He said the varicose veins could be causing this but could it be the uterus or progesterone injection causing this. Since so many veins have been effected, I'm not sure how many more will be or if the varicose veins and perforating veins in thigh lump is causing other veins problems. I don't feel like I have much time to get this fixed and under control. Dr. Did not prescribe any medication, but I am taking horse chestnut on my own

I will try to get my report of venous ultrasound to you .


Myomectomy was done laproscopic but surgery did not go well. She left a large fibroid behind that grew very large After depo shot and I ended up with adenomyosis as well after the surgery causing uterus to become as large as 17 cm I think, so this could be contributing to the varicosities and general insufficiency. They said they could not see for sure if uterus was having an effect on my legs veins.
doctor
Answered by Dr. Rishi (16 hours later)
Brief Answer:
Uterine compression can lead to Venous insufficiency.

Detailed Answer:
Hello.
Thanks for your answer.
Laparoscopic myomectomy should not lead to any problems.
However enlarged Uterus along with a Large Fibroid can lead to compression.
But First I need to know what kind of reflux it is as I asked in my last answer. That will determine the treatment. The twitching in the legs is likely due to Venous congestion which is maximum in the ankles and calves and decreases as we come towards the body. Once the Reflux is treated the twitching and pain should decrease.
It is fairly normal to be unable to detect any Venous compression on imaging.
Please send me the reports in order for me to help you.
Take care.
Dr Rishi.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Rishi (34 hours later)
Hi Dr. I have have sent for my report and you should have it early next week. I was told that I have both superficial and deep insufficiency.

I just wanted to ask in the meantime if you meant it is possible for the uterus to be the cause of the insufficiency but not show any blocked veins or pressing of the veins by uterus. They said they so not see uterus compression as the cause despite it's large size.

Last, while are waiting for you to get the report, my legs are hurting bad. Mostly soreness and feeling of fatigue and inflammation. Is this normal with this condition? I have noticed that my legs are better today as far as not feeling insufficiency so much as just the pain. I have been taking horse chestnut and I think that is helpful but I am a long way from being out of the woods on this.

Thanks for your advice so far.
XXXX
Also it seems to feel better if I walk around. Why is that?
doctor
Answered by Dr. Rishi (1 hour later)
Brief Answer:
Wear tighter stockings.

Detailed Answer:
Hello,
Thanks for your answer.
If you have both Superficial and Deep insufficiency then the Superficial part can be dealt with using Laser surgery and you should feel better with that. But lets wait for the report to decide upon that.
If they say they cant see any compression by the Uterus then it is unlikely to be the cause for the insufficiency.
Soreness and fatigue can happen with CVI. It improves with walking because the calf muscles pump out the blood from the leg towards the heart during walking and the venous pressure in the leg decreases.
Please wear tighter stockings upto 35 to 40mm Hg pressure. And take Tab Daflon 500mg twice a day and you will feel better. If there is severe pain you can take a Tab Tramadol.
Take care and look forward to hearing from you.
Regards,
Dr Rishi.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Rishi

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Suggest Treatment For Venous Insufficiency On Both Legs

Brief Answer: Need to know details about the Reflux. Detailed Answer: Hello. Welcome to Health Care Magic and Thank you for your question. I am a Vascular Surgeon and will try to help you. It would be very helpful if you could share your Doppler report with me. I need to know whether you have deep reflux or superficial or both. Superficial reflux can be managed with Laser surgery easily but not Deep reflux. Deep reflux does not completely go away. The Uterus can be a cause and removal might help if any imaging proves Venous compression by the Uterus Physical tiredness and exhaustion can't be explained by CVI. The myomectomy surgery was done by Laparoscopy or Open? Tight compression stockings are a must and you should also start having Tab Daflon 500mg twice a day. This will help the Venous Reflux. Do let me know the answers to above questions and your reports as well. Take care and do not worry. Look forward to hearing from you. Regards Dr Rishi, New XXXXXXX XXXXXXX