Venous and Lymphatic
Jeannette K. Chang, M.D., F.A.C.S.
Michael N. Tameo, M.D.
Ronald L. Nath, M.D. , F.A.C.S.
Weight Loss Surgery
May 28, Tuesday 6:00 pm
Where: Courtyard Boston Woburn/Boston North Hotel
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Venous insufficiency refers to a defect, or ‘insufficiency’, of the venous
system in the lower extremities causing swelling, pain, varicose veins (which
can cause pain), and changes to the skin including red or brown pigmentation
(known as stasis dermatitis), dry scaling, ulcers, and infection. The
abnormality is usually a failure of the veins to properly return blood upward to
the heart. This causes a ‘back-up’ of blood in the leg veins that raises the
venous pressure, which in turn forces the fluid within blood to leak out into
the tissues causing swelling. The elevated pressure also forces blood back into
the smaller veins in the subcutaneous tissue under the skin causing varicose
veins, which can cause pain and if located under ulcers or wounds, can prevent
There are 2 types of venous insufficiency. Primary, or deep, venous
insufficiency involves the deep veins in the leg and causes swelling which
leads to skin changes as mentioned above and impaired healing of ulcers,
wounds, and infection. Superficial venous insufficiency involves the great
and/or small saphenous veins and causes swelling, painful varicose veins,
reticular and spider veins, skin changes, and impaired healing of ulcers,
wounds, and infection. Lymphatic insufficiency refers to a defect in the
lymphatic system from trauma, previous surgery, or nerve injury. The
lymphatic system helps return fluid from tissues of the extremities and thus
this defect can cause swelling (lymphedema) that causes symptoms similar to
that of primary/deep venous insufficiency. Complications from venous and
lymphatic insufficiency include severe wounds and/or infection, which fail
to heal causing gangrene and possible loss of limb.
Diagnosis of venous or lymphatic insufficiency and their associated complications
requires a thorough history and physical exam by a vascular surgeon. A
specific type of ultrasound of the venous system in the legs is required,
which we perform at our office in our accredited non-invasive vascular lab.
Patients can receive the required test and be seen by their vascular surgeon
at the same visit. Occasionally, a computed tomography (CT) scan or venogram
is required. Venogram involves injection of contrast dye into the vein for
Treatment of primary/deep and lymphatic insufficiency requires
compression therapy with prescription-strength compression stockings. If
ulcerations or wounds developed, then alternative methods of compression may
be required, which incorporate wound care techniques. For severe cases or
for those who are not candidates for traditional compression therapy, a
compression pump may be required. Treatment of superficial venous
insufficiency (including varicose veins) often requires a catheter
procedure, which we perform in our office, to close the abnormal veins. If
not a candidate for this technique, then microphlebectomy (removal of veins
through tiny incisions) and/or sclerotherapy (injection of veins with a
sclerosing agent) may be needed.