Peripheral venous disorders refer to defects or damage in the peripheral veins, which carry oxygen-poor blood away from the extremities (such as the hands and feet) and to the heart to receive oxygen. (This is different from peripheral arterial disease, which refers to problems with the peripheral arteries).
Peripheral venous disorders include thrombophlebitis, varicose veins and chronic venous insufficiency. Some of these conditions (e.g., a form of thrombophlebitis called superficial vein thrombosis) are generally harmless. However, other conditions (e.g., deep vein thrombosis) can be life-threatening.
In general, treatment for chronic peripheral venous disorders involves exercising the affected area (e.g., the legs) and elevating and bandaging the area as much as possible (e.g., compression therapy). Often, patients with acute venous disorders will also need to take anticoagulants (e.g., warfarin) as an initial treatment for their venous blood clots. Medications and surgeries are also available, if necessary.
About peripheral venous disorders
Whereas peripheral arterial disease refers to problems with the peripheral arteries, peripheral venous disorders refer to defects or damage in the peripheral veins, which carry oxygen-poor blood away from the extremities and toward the heart. The peripheral veins are located in areas of the body such as the feet, legs, lower abdomen, arms, neck and head.
In the legs, where the majority of peripheral venous disorders occur, the venous system consists of superficial veins and deep veins. These parallel sets of veins are connected by perforating veins, which travel from the skin surface deeper into the tissue. Blood flow through veins is less forceful than arterial blood flow because, unlike arteries, veins are not muscular organs that contract in concert with the heart. Thus, to keep blood flowing in the right direction (and against gravity), veins have valves that open and shut, allowing oxygen-poor blood to flow only toward the heart. Damage to any of the vein systems or valves is known as a peripheral venous disorder.
Peripheral venous disorders include:
Thrombophlebitis. Inflammation of a vein due to an obstructing blood clot. There are two types: superficial vein thrombosis (SVT) or deep vein thrombosis (DVT). SVT occurs when blood clots form in veins located just below the skin’s surface, which can cause pain, engorgement and visible distortion of the vein.
A closely related condition, known as superficial phlebitis, occurs when the vein is inflamed even though blood clots may not be present. Although discomforting, the condition is generally not considered a serious risk for pulmonary embolism. It can, however, sometimes progress to deep vein thrombosis. This condition occurs in the larger veins of the leg, further below the skin's surface. Deep vein thrombosis is a major risk factor for pulmonary embolism, which may be caused when the blood clots obstructing the veins dislodge, travel to the lungs and cause an obstruction.
Varicose veins, abnormally dilated veins that are swollen, dark colored and frequently contorted. They are seen most commonly in the superficial veins just under the skin, especially those at the back of the calf and thigh. They tend to occur more frequently in women than men.
Chronic venous insufficiency (CVI), a condition in which the deep or superficial veins do not channel blood flow properly, permitting reverse blood flow and causing leg swelling, skin discoloration and permanent damage to the surrounding skin.
Peripheral venous disorders can result when the blood flow to the peripheral veins is slowed down as a result of any of the following circumstances:
Injury or surgical trauma, especially intravenous catheters
Major medical illnesses
Physical inactivity
Sitting or standing for long periods of time (e.g., long airplane or car trips)
Risk factors include:
Smoking
Heart disease
Diabetes
High blood pressure
Certain types of cancer
Use of oral contraceptives or hormone replacement therapy
Obesity
Recent surgery
Long bone fractures or other major traumatic events
Prolonged bedrest from a major medical illness
Prior history of deep vein thrombosis or other venous disorder
Congenital deficiency of naturally occurring anticoagulants in the body such as antithrombin III deficiency
Pregnancy or recent childbirth
Nearly 6 million Americans have or have had a blood clot in their veins, a condition that can become life-threatening if it completely blocks blood flow in the vein (a thrombus) or if that clot (or any part of it) breaks off, travels through the bloodstream and becomes lodged in another blood vessel (typically in the lung, known as a pulmonary embolism).
Signs and symptoms
Signs and symptoms of a peripheral venous disorder depend on which type of disorder is present. About 50 percent of patients with a new blood clot have no or very mild symptoms. Other patients may experience symptoms such as:
Mild inflammation
Fever
Swelling, redness and tenderness to touch, especially in the calf or thigh
Warmth in the affected area
Pain and discomfort when the foot is raised upward (especially in deep vein thrombosis)
Treatment & prevention options
Lifestyle changes that are helpful in preventing chronic peripheral venous disorder include:
Exercise (especially before surgery and during extended periods of sitting or standing)
Weight control
Smoking cessation
In addition to the measures listed above, lifestyle changes that are helpful in treating chronic peripheral venous disorder include:
Leg elevation whenever possible
Warm moist compresses applied to the affected area
Compression therapy with compression stockings
Wearing loose clothing
Low salt diet to minimize swelling
Medications may also be prescribed, including:
Anticoagulants. Medications such as heparin or warfarin help prevent the formation of new blood clots and help prevent new clots from growing larger or breaking off to the lungs.
Nonsteroidal anti-inflammatory drugs (NSAIDs). These may be given to relieve symptoms.
Clot-busting drugs. These may be administered through an intravenous (I.V.) line to dissolve a clot, particularly if the patient is in crisis (e.g., massive pulmonary embolism). However, there is an increased risk of more bleeding.
Interventional or surgical treatments of peripheral venous disorders may include:
Thrombectomy. A procedure in which the involved vein is surgically opened and the clot is excised (cut out).
Injection, or sclerotherapy. A procedure in which a salt solution or other sclerosing agent (an irritating substance) is injected into the offending veins, which causes them to shrink away. This is used for treatment of superficial veins.
Ambulatory phlebectomy. A series of tiny skin punctures performed under local anesthesia that remove smaller varicose veins.
Vein stripping. A procedure in which segments of large varicose veins are surgically removed.
Endoscopic vein surgery. A procedure in which a small endoscope is inserted into the veins in order to visualize and then remove the vessel-based (vascular) abnormalities. This procedure can help heal ulcers of the legs.
Laser therapy or radiofrequency therapy. To obliterate painful or cosmetically bothersome veins.
Placement of a filter in the inferior vena cava. This is the vein that drains blood from the lower half of the body. A filter may be placed in patients who have a contraindication for anticoagulation or who develop pulmonary embolism despite being treated with an anticlotting agent.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to peripheral venous disorders:
How dangerous is my condition?
How at risk am I for peripheral venous disorders?
How urgently do I need to begin treatment?
What part of my body has sustained vein damage or has abnormalities?
What type of treatment do you recommend for my specific condition? Will I need to have a surgical procedure?
Am I currently taking any medications that might have caused this condition? Will any of the medications I am taking interfere with your recommended treatment?
Is there anything I can do to relieve the pain associated with my condition?
Are there any lifestyle changes I can make to improve my condition?
How important is it that I quit smoking?
Will my peripheral venous disorder affect my ability to get pregnant? Could the condition harm my unborn child?
