DEEP VEIN INSUFFICIENCY

​

The veins in our legs consist of superficial veins and deep veins and also perforating veins that connect them. The mission of the vein system is to carry the deoxygenated blood in the leg to the lung to ensure circulation. The most important veins of our legs are deep veins. If we compare the venous circulation to the traffic flow, deep veins are like highways, superficial veins boulevards and perforating veins small streets.

 

Venous insufficiency (venous valve insufficiency, leakage, reflux) is more common in superficial veins (about 95%) because there is less supportive tissue around the superficial veins and their valves are weaker. Deep veins, on the other hand, are more protected by the surrounding tissue and their valves are thicker and more resistant. Therefore, deep vein insufficiency is much rarer.

 

In the treatment of varicose veins, the aim is not to repair defective valves, but to destroy the incompetent vessel by using laser, radiofrequency or other methods. In superficial vein insufficiency, as long as the deep veins are healthy, the incompetent vessel can be removed or ablated safely. The leg does not suffer from this condition because: 1. Deep veins, which are the main veins of the leg, function normally. 2. The function of the vessel to be treated has already been transferred to other healthy vessels years ago. Therefore, the treatment does not harm the leg, on the contrary, since the venous blood will no more accumulate in the leg, the blood circulation improves.

 

if the insufficiency is in the deep veins, the situation is different. Since deep veins are the essential veins of our legs, they cannot be ablated or surgically removed. As a result, if there is deep vein insufficiency, invasive treatments can not be performed, instead, palliative methods such as medication, lifestyle change and compression stockings are generally applied.

 

 

Fortunately, true deep vein insufficiency is rare and is almost always due to previous deep vein thrombosis (DVT). In deep vein thrombosis, even if the clot is completely lysed, the clot-induced inflammation permanently destroys the valves and causes severe deep vein insufficiency. Unfortunately, there is no radical treatment of this type of deep venous insufficiency, which is called post-thrombotic syndrome, and conservative treatment is recommended.

​

​

​

​

 

 

 

 

 

 

 

 

 

 

 

 

 

​

​

Superficial vein can be treated in some cases of deep venous insufficiency

Deep vein insufficiency may sometimes occur due to prolonged superficial vein insufficiency. In superficial vein insufficiency, the venous blood flowing back to the leg is directed to the deep veins through the perforating veins and the deep veins carry this blood up to the lung. If this phenomenon persists for years, valve failure also develops in deep veins that work more than normal due to the continuous load of the superficial veins. Such deep vein insufficiency is less severe than the classical deep vein insufficiency developed after thrombosis, and if superficial vein insufficiency is treated, deep vein insufficiency may regress in some of these patients.

 

Accurate recognition of deep vein insufficiency due to superficial vein insufficiency is very important because interventional treatments can and should be performed in these patients. However, in practice, ultrasound reports of such patients indicate the presence of deep vein insufficiency, and the surgeon who sees this report may refuse to treat the patient. As a result, this patient group, which can be easily treated by interventional methods, is doomed to live with varicose veins for their lives because of an incorrect ultrasound evaluation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

​

​

​

​

​

​

​

Importance of color Doppler ultrasound in the evaluation of deep venous insufficiency

Deep vein insufficiency is diagnosed by color Doppler ultrasound examination. However, this examination should be performed carefully and by experienced physicians who know the treatment of varicose veins. Based on my personal experience, I can say that the following problems exist in the diagnosis and treatment of varicose veins:

 

1. In varicose veins, color Doppler ultrasound is performed in a supine position, instead of standing in many centers. Color Doppler ultrasound performed in the supine position may incorrectly show deep vein insufficiency even in normal individuals.

 

2. In deep vein insufficiency due to superficial vein insufficiency, color Doppler ultrasound can be used to decide if superficial vein insufficiency is more severe, and deep vein insufficiency will regress after ablation. If superficial vein insufficiency is less and deep vein insufficiency is more, the treatment can be more harmful than beneficial. Unfortunately, no such information is provided on most color Doppler examinations.

 

3. In patients with deep vein failure due to deep vein thrombosis, it should be made clear whether the deep veins are open or not. Because, especially  if the deep veins below the groin are open and "iliac" veins above the groin are obstructed, this obstruction can be opened with a stent and the patient can benefit from it. Patients with deep vein thrombosis should also be evaluated in this respect.