Treatment of Chronic Venous Insufficiency Case Study Overview [Dr. Donikyan]

The Fishkill, NY location provides a full range of minimally invasive-image guided procedures. Dr. Donikyan’s compassionate, patient-centered approach to endovascular care helps you feel at home while you get back on your feet.

Patient History and Consultation

  • 76-year-old female presents with severe bilateral lower extremity swelling and discoloration.  She also reported a heavy feeling in her legs which limited her ability to walk.
  • Flaking skin with a non-healing wound on the right anterior shin.  These changes have progressed over the past 6 years.
  • CEAP 4B disease bilaterally.
  • The patient has been using compression therapy for over 12 months.

Patient Plan and Treatment

  • Doppler Ultrasound: Shows significant bilateral Great Saphenous vein reflux of 2 seconds or greater from saphenofemoral junction to below the knee Great Saphenous vein.

  • EVLT: Bilateral Laser ablation of the Great Saphenous vein using tumescent anesthesia and conscious sedation.  The legs were treated separately, about 3 weeks apart.

Patient Follow-Up

  • The patient returned 8 weeks after treatment of both legs.
  • Ultrasound was performed confirming occlusion of bilateral Great Saphenous veins.
  • Significant improvement in swelling and discoloration.
  • Near complete healing of right anterior shin wound.
  • Improved skin texture.
  • Improvement of heavy feeling and discomfort in legs.  The patient is now able to walk more throughout the day.

Before and After Images

Discussion

  • Our patient presented with skin changes and active non-healing wounds secondary to chronic venous insufficiency.  This affected her ability to walk throughout the day.
  • Doppler ultrasound diagnosed bilateral GSV insufficiency.
  • EVLT was performed with mild sedation in an outpatient office.  Procedure time 20 minutes.
    – Alternative treatments include VenaSeal, Sclerotherapy, etc.
  • 8-week initial follow-up shows significant improvement in leg swelling, discoloration, and skin texture.  Wounds are also almost completely healed.
  • Improved ability to walk, improved quality of life.

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