Venous Disease

Venous disease — including varicose veins, chronic venous insufficiency, and deep vein thrombosis — can cause significant discomfort, swelling, and long-term complications if left untreated. At Makam Medical, Dr. Arjun Makam, DO, FACC, evaluates and manages venous conditions as part of a comprehensive approach to vascular health. Serving patients at our Anaheim and Corona, CA offices — call us or request an appointment online today.

What is venous disease?

Venous disease refers to conditions affecting the veins — the blood vessels responsible for carrying deoxygenated blood back to the heart. Unlike arteries, which have the force of the heartbeat to propel blood forward, veins rely on a series of one-way valves and the contraction of surrounding muscles to move blood upward against gravity. When those valves weaken or fail, blood flows backward and pools — and the consequences range from cosmetic concerns to serious, limb-threatening complications.

The legs are the most commonly affected area, simply because they face the greatest gravitational challenge. Venous disease in the legs is extremely common and significantly undertreated — many patients live with symptoms for years before seeking evaluation.

What are the most common types of venous disease?

Chronic venous insufficiency (CVI) CVI develops when the one-way valves in the leg veins become damaged or incompetent, allowing blood to reflux downward and pool in the lower legs. The resulting increase in venous pressure causes a cascade of progressive changes over time. Left untreated, CVI worsens. Symptoms and complications include:

• Leg heaviness, aching, or fatigue — particularly after prolonged standing or sitting
• Swelling in the ankles and lower legs (edema)
• Skin changes including discoloration, thickening, or a brownish staining caused by iron deposits from leaked red blood cells
• Skin rash or dermatitis over the lower leg
• Varicose veins
• Venous leg ulcers — open wounds that develop near the ankle and are notoriously difficult to heal without addressing the underlying venous dysfunction

Venous leg ulcers are a serious complication that require specialized wound care and treatment of the underlying CVI. They do not reliably heal on their own.

Varicose veins Varicose veins develop when vein walls and valves weaken, allowing blood to pool and veins to enlarge, twist, and bulge beneath the skin. They vary in size from small rope-like cords just beneath the surface to large, tortuous vessels clearly visible through the skin. While often considered a cosmetic issue, varicose veins can cause significant symptoms — including aching, heaviness, itching, cramping, and swelling — and represent an underlying problem with venous valve function that can progress if untreated.

Risk factors include prolonged standing or sitting, pregnancy, obesity, family history, and aging.

Deep vein thrombosis (DVT) DVT occurs when a blood clot forms in a deep vein, most commonly in the calf, thigh, or pelvis. It can develop after prolonged immobility, surgery, long-distance travel, or in patients with inherited clotting disorders or active malignancy. DVT may cause leg pain, swelling, warmth, and redness — but in some cases causes no symptoms at all.

DVT requires prompt evaluation and treatment. The primary danger is pulmonary embolism — when a clot breaks free and travels through the bloodstream to the lungs. A large pulmonary embolism is a life-threatening emergency. If you develop sudden shortness of breath, chest pain, or rapid heart rate — particularly in the setting of recent leg swelling — seek emergency care immediately.

Superficial thrombophlebitis Inflammation and clotting within a superficial vein just below the skin surface, often occurring in a varicose vein. It causes localized pain, redness, and a firm, tender cord along the vein. While generally less dangerous than DVT, superficial thrombophlebitis can occasionally extend into deep veins and warrants evaluation.

What symptoms should prompt a venous evaluation?

• Persistent leg swelling, particularly if one leg is more swollen than the other
• Leg pain, heaviness, or fatigue that worsens with standing and improves with elevation
• Visible varicose veins, especially if accompanied by symptoms
• Skin changes in the lower leg — discoloration, thickening, or rash
• An open wound or ulcer near the ankle that is slow to heal
• Sudden leg swelling with pain, warmth, or redness — particularly after travel, surgery, or prolonged immobility

What can I expect at a venous disease consultation?

Dr. Makam conducts a thorough evaluation tailored to your specific symptoms and history. Your consultation includes a detailed review of your medical history, family history of venous disease or clotting disorders, current medications, and how your symptoms affect your daily life. A physical examination of the affected extremities is performed.

Diagnostic testing may include:

• Venous duplex ultrasound: The primary imaging tool for evaluating venous disease. It assesses blood flow, valve function, and identifies the presence of clots in both deep and superficial veins. It is non-invasive, painless, and highly accurate.
• Additional imaging when indicated for complex or atypical presentations

What treatments are available for venous disease?

Treatment depends entirely on the type and severity of your condition. Options range from conservative management to procedural intervention:

• Compression therapy: Graduated compression stockings reduce venous pressure, improve symptoms, and slow the progression of CVI. They are a cornerstone of management for most venous conditions.
• Lifestyle modifications: Elevation of the legs, regular walking, weight management, and avoiding prolonged immobility all reduce venous pressure and improve symptoms.
• Anticoagulation: For DVT and pulmonary embolism, blood-thinning medications are the primary treatment to prevent clot extension and embolization.
• Procedural options: For patients with significant varicose veins or CVI who have not responded to conservative measures, procedural treatments including endovenous ablation, sclerotherapy, or surgical referral may be appropriate.
• Wound care coordination: For patients with venous leg ulcers, treatment of the underlying venous insufficiency is essential alongside dedicated wound care.

For venous disease evaluation at our Anaheim or Corona, CA offices, call Makam Medical or request an appointment online today.