Expert: Lauri Ordway - 10/13/2000

Question
IS PERIPHERAL VENOUS DISEASE AS SERIOUS AS PERIPHERAL ARTERIAL DISEASE? I AM REFERRING TO LEG PAIN RELATED TO POSSIBLE VASOSPASM FROM SMOKING. MY DISTAL ARTERIAL PULSES ARE, ON A 1 TO 5 SCALE, 5 BEING THE BEST, A 5+, BUT STANDING ON MY LEGS ALL DAY, AS A NURSE,I HAVE NOTICED BY THE END OF THE DAY, I AM IN SEVERE PAIN WITH MY LEGS. I HAVE TRIED JUST ABOUT EVERYTHING I KNOW TO QUIT SMOKING, BUT TO NO AVAIL. PLEASE HELP ME WITH AN ANSWER. SINCERELY, LINDA POWERS

Answer
linda
in general venous problems are not as serious as arterial, until you get to something like DVT or Phlegmasia cerulea dolens which is a severe form of deep venous thrombosis, usually the upper leg. It usually comes on suddenly and produces swelling and loss of normal color in the leg beyond the blockage (turns the leg white or blue)

vasospasm is a sudden, brief tightening of a blood vessel; which can temporarily reduce blood flow to tissues supplied by that vessel

varicose veins are enlarged, twisted veins with nonfunctioning valves,the valves do not function properly, allowing blood to remain in the vein. pooling of blood in the vein causes it to enlarge
they are very common, 1 out of 10 people, mostly women between the ages of 30 and 60.  causes include defective valves, thrombophlebitis, and pregnancy

prolonged standing or sitting, poor posture, and increased pressure within the abdomen will both increase susceptibility and / or aggravate them

you need a venous duplex ultrasound to look for venous valvualr incompetence (not just DVT which is what they are usually looking for- they will chaeck for DVT but make sure you get an experienced tech, who can determine the anatomy and function of the veins

vein stripping and ligation may be recommended

to do for yourself: elevate legs whenever possible to increase blood drainage, avoiding prolonged standing or sitting, and regular exercise to increase circulation 20-30mmg elastic stocking can increase blood flow and relieve discomfort (i wear these EVERY day! and have no problems with VV)

v veins worsen over time, discomfort and progression may be lessened with sox and elevation

waht can happen without treatment is phlebitis (chronic inflammation of the vein) or deep vein thrombosis and hemosiderin deposition turns your ankle area brown (which cannot be "fixed" and eventualy you will get venous ulceration

get the ultrasoudn, wera the sox (shower at night and put your sox on before you get OOB in teh morning)

smoking is NOT a cause or comtributor to Varicose Veins

Snoking DOES injuere the insides of your arteries and there is no doubt that it is hard to quit, I have had 3 folks, in 8 years of working with vascular patients, who chose amputation of their legs over stopping smoking...if that does not put the fear of god in you, I dont know what will.
please, find a way to stop smoking.

lauri