These include the following conditions:

1. Deep Venous Thrombosis
2. Deep Venous Insufficiency
3. May Thurner’s Syndrome
4. Pelvic Congestion Syndrome
5. Varicocele
6. Nutcracker Syndrome

• Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg.
• This is a serious condition if a piece of the blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs (see below).
• DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

SYMPTOMS OF DVT

One/both of your legs may show

• Heaviness, tenderness, or throbbing of the leg.
• Pain that feels like a cramp.
• Skin that’s warm to the touch.
• Swelling.
• Veins that look larger than usual.
• Changes in skin color (more red or purple than normal in fair individuals).

in severe cases- change in color of skin to blue/black indicating the death of tissue due to blockage of blood supply(phlegmasia).

If left untreated, about 1 in 10 people with a DVT will develop a pulmonary embolism. A pulmonary embolism is a very serious condition that causes:

• breathlessness – which may come on gradually or suddenly.
• chest pain – which may become worse when you breathe in.
• sudden collapse.
• coughing blood.

Anyone can develop DVT, but it becomes more common over the age of 40.

Risk factors, including:

• having a history of DVT or pulmonary embolism.
• having a family history of blood clots.
• being inactive for long periods – such as after an operation or during a long journey.
• blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot.
• having certain conditions or treatments that cause your blood to clot more easily than normal – such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia, and Hughes syndrome.
• being pregnant – your blood also clots more easily during pregnancy.
• being overweight or obese.

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen, which causes the blood to clot more easily. If you’re taking either of these, your risk of developing DVT is slightly increased.

D-dimer test

• Detects pieces of a blood clot that have been broken down.
• The larger the number of fragments found, the more likely it is that you have a blood clot in your vein.
• However, the D-dimer test isn’t always reliable and additional tests may be required.

Ultrasound scan

• It is a standard baseline test for any patient suspected of having a DVT.
• Doppler ultrasound detects the presence of a clot and its age, sites affected, and also how fast the blood is flowing through a blood vessel.

• A CTvenogram may be used if the results of a D-dimer test and ultrasound scan can’t confirm a diagnosis of DVT or DVT is suspected in areas of the body where ultrasound cannot be done reliably.
• Also sometimes helps to detect the cause of the DVT.

Conservative

• Most patients do not need any form of procedure to treat the clot and can be managed conservatively with medications.
• Treatment for DVT usually involves taking anticoagulant medicines(blood thinners), which reduce the blood’s ability to clot and stop existing clots from getting bigger.
• Heparin and warfarin/coumarin are 2 types of anticoagulants often used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting.
• New drugs called directly acting oral anticoagulants (DOACs), or NOACs (for Novel or Newer -) may also be used to treat conditions such as DVT. These medications are shown to be as effective as heparin. Stockings help to relieve the swelling in the leg and are generally recommended for a few months.

• Strong clot-dissolving medications(thrombolytics) are given directly into the vein inpatient with extensive DVT.

• Using negative pressure pumps to suck out the clot from the veins.
• Helps to avoid thrombolytics or reduce its dose used(thereby reducing its complications).

• If a narrowing(stenosis) or block(occlusion) is detected in the major veins draining the leg, then angioplasty and stenting may be needed to improve the blood flow in the vein and provide rapid symptom improvement.

• You might get this if you can’t take blood thinners or if they don’t work well for you. 

• The filter won’t prevent clots from forming but will catch them before they end up in your lungs.

• The filter can be removed after a specified period of time.

CHRONIC VENOUS INSUFFICIENCY/VENOUS ULCERS

• Chronic venous insufficiency and leg ulcers affect approximately 1-2 people per 1000 of the general population.
• Ulcer healing rates can be poor with up to 50%  unhealed for 9 months.
• Ulcer recurrence rates are worrying -one-third of treated patients on their fourth or more episode.
• Leg ulcer treatment affects the quality of life.

• Chronic venous insufficiency is a term used to describe the changes that can take place in the tissues of the leg, due to longstanding high pressure in the veins.
•  This high pressure in the veins usually occurs because.
• Blood flow in the veins is abnormal, secondary to valvular incompetence, causing reflux (reverse flow) in the veins.
• Veins in the legs become blocked.
• Varicose veins cause low-level chronic inflammation in the surrounding tissues.

Correctable risk factor

• Overweight
• Physically inactivity
• Smoking
• Avoiding long-standing

Chronic venous insufficiency commonly involves the gaiter area of the leg (the lower half of the leg above the ankle and around the ankle). The classical changes are

Pigmentation
The brown discoloration occurs when blood cells leak out of the blood vessels and then permanently deposit in the tissues.

Ulceration
Severe damage causing loss of area of skin has been lost.

• Long-standing
• Recurrent
• Non-healing
• Multiple treatment options tried and failed

Lipodermatosclerosis (LDS or liposclerosis)
This refers to a thickening in the tissues underneath the skin.

They become hard and woody and lose all their normal suppleness.

Eczema
Skin becomes red, weeps watery fluid, and scaly.

Abnormal appearance to the shape of the leg (inverted champagne bottle)
The leg is very narrow at the ankle and just above, but then becomes much fatter in the upper part of the calf below the knee.

Swelling
Swelling around the ankle, foot and lower leg can be a sign of venous problems.

Complete medical history and physical examination.

Duplex ultrasound 
It’s an ultrasound scan to test the speed and direction of blood flow in the veins.

CT Venogram
CT scans of the veins are done by injecting a dye(contrast) to gain more information on the veins not accessible through a duplex scan.

Treatment will depend on many factors, including the reason for the condition and your health status and history. Other factors your doctor will consider are:

• your specific symptoms.
• your age.
• the severity of your condition.
• how well you can tolerate medications or procedures.

COMPRESSION STOCKINGS

• Most common treatment option.
• Apply variant pressure at the ankle and leg level.

MEDICATIONS

• Some drugs may help to relieve crampy pain in the leg and help to improve strength to the vein wall.

• Injecting a  solution into the targeted veins.
• Sclerosing solution irritates the vein lining and turns it into scar tissue.

•  Multiple sessions are needed.
• Also used as additional treatment after Ablation procedures.
• Also used primarily for recurrent varicose veins.

• Minimally Invasive Principle- procedure delivers Laser via a catheter to the vein, which shrinks in the heat and eventually closes.
• Anesthetic and a saline solution are also injected to numb the leg, squeeze blood from the vein and protect surrounding tissue.
• Ultrasound imaging is used to locate the treatment site, guide the catheter and confirm that the vein has been fully closed.

• The  VENASEAL™  procedure- uses a medical adhesive to seal the vein.
• The risks of blood clots, infections, and other complications are extremely low as is the probability of recurrence. Recovery is very fast.

• Vein Stripping and Vein Ligation- An incision is made over the varicose vein, the vein is tied off, and stripping (surgical removal of the varicosed vessel) is done to remove large varicose veins from the body. Ambulatory phlebectomy- making small pricks and removing smaller damaged veins.

• compression- 4 layer bandage or stockings.
• medications- to control infection.
• sclerotherapy- to block the small veins near the ulcer site.
• Ablation procedure- RF/Laser/Glue to block the main culprit vein causing the ulcer.

HOW TO PREVENT VENOUS INSUFFICIENCY

Lifestyle changes that can be made in order to reduce your risk of developing this condition include:

• Exercising regularly.
• Maintaining a healthy weight.
• Elevating the legs.
• Avoid sitting or standing in one position for too long.
• Adequate skin care to maintain the integrity of the skin.
• Compliance with stockings use.

What Is May-Thurner Syndrome?

• In May-Thurner syndrome, the right iliac artery (which carries blood to your right leg) squeezes the left iliac vein (which brings blood out of your left leg toward your heart) when they cross each other in your pelvis. Because of that pressure, blood can’t flow as freely through the left iliac vein. It’s a bit like stepping part way down on a hose.
• The result: You’re more likely to get a deep vein thrombosis (DVT) in your left leg. A DVT is a type of blood clot that can be very serious. It’s not just that it can block blood flow in your leg. It can also break off and cause a clot in your lung. That’s called a pulmonary embolism, and it’s life-threatening.

SYMPTOMS

You likely won’t even know you have it unless you get a DVT. You might get pain or swelling in your leg, but usually, there aren’t any warning signs.

With a DVT, your left leg may show symptoms such as:

• Heaviness, tenderness, or throbbing of the leg.
• Pain that feels like a cramp.
• Skin that’s warm to the touch.
• Swelling.
• Veins that look larger than usual.
• Changes in skin color (more red or purple than normal in fair individuals).
• in severe cases- change in color of skin to blue/black indicating the death of tissue due to blockage of blood supply(phlegmasia).

If the DVT clot breaks off and moves to your lungs (Pulmonary Embolism), you’ll notice:

• Chest pain that’s worse when you breathe in.
• Coughing up blood.
• A heartbeat that’s faster than normal.
• Passing out.
• Shortness of breath or other problems breathing.

DIAGNOSIS

Your doctor will first do a physical exam to look for signs and symptoms of a DVT. From there, you may need imaging, such as:

• CT or MRI
• Ultrasound
• Venogram, a type of X-ray that uses a special dye to show the veins in your leg

TREATMENT

• There are two goals: to treat any clots you already have and to keep new ones from forming.
• Treatment for DVT usually involves taking anticoagulant medicines(blood thinners), which reduce the blood’s ability to clot and stop existing clots from getting bigger.
• Heparin and warfarin/coumarin are 2 types of anticoagulants often used to treat DVT. 
• Heparin is usually prescribed first because it works immediately to prevent further clotting. 
• New drugs called directly acting oral anticoagulants (DOACs), or NOACs (for Novel or Newer -) may also be used to treat conditions such as DVT. These medications are shown to be as effective as heparin.
• Stockings help to relieve the swelling in the leg and are generally recommended for a few months.

Thrombolysis

Strong clot dissolving medications(thrombolytics) given directly into the vein in patient with extensive DVT.

• Using negative pressure pumps to suck out the clot from the veins
• Helps to avoid thrombolytics or reduce its dose used(thereby reducing its complications)

• If a narrowing(stenosis) or block(occlusion) is detected in the major veins draining the leg, then angioplasty and stenting maybe needed to improve the blood flow in the vein and provide rapid symptom improvement

• You might get this if you can’t take blood thinners or if they don’t work well for you. 
• The filter won’t prevent clots from forming but will catch them before they end up in your lungs.