Restless leg syndrome

Venous insufficiency or varicose veins is an often-overlooked cause of RLS. Several studies indicate that as many as 22 percent of those with RLS also have venous insufficiency. When restless legs occur with venous insufficiency, the RLS can be improved significantly by treating the varicose veins.

A study published in the Journal of Phlebology reported that in patients with both RLS and venous disease, 98 percent had their RLS symptoms relieved with varicose vein treatment and 80 percent experienced long-term relief.

This beleaguering condition, in which a patient’s veins are chronically unable to properly pump enough oxygen-poor blood back up to the heart, is due to damaged vein valves. Also sometimes referred to as “impaired muscle venous pump,” the affliction besets people that have to stand for long hours like Martin, who is a chef on a cruise ship.

However, the condition also appears in men and women who are obese, women who have had several pregnancies, and those whose job entails standing for long periods of time without moving. The veins are more than unsightly, as they also cease to function at an optimum level. And so, large, bulging, tortuous veins appear together with venous insufficiency.

It can also happen to people who develop a blood clot in the deep veins of the legs, a disease known as deep vein thrombosis (DVT) in those with pelvic tumors and vascular malformations (an abnormal development of blood vessels). Sometimes they occur for unknown reasons. Failure of the valves in leg veins to hold blood against gravity leads to sluggish movement of the blood out of the veins, resulting in increased pressure leading to varicose veins, swollen legs, and RLS. This can occur almost anywhere, but most commonly in the legs.

If venous insufficiency is not treated, the pressure and swelling increase until the tiniest blood vessels in the legs (capillaries) burst.

Burst capillaries can cause local tissue inflammation and internal tissue damage, resulting in skin thickening and loss of elasticity. This leads to deep ulcers or open sores on the skin surface.

These venous stasis ulcers can be difficult to heal and can become infected. When the infection is not controlled, it can spread to surrounding tissue, a condition known as cellulitis.

The venous system has deep and superficial veins. The deep veins are the major veins, which return the blood to the heart. These lie within the muscles of the legs and arms.

The superficial veins collect blood from the skin and take blood through the communicating veins (veins that connect the superficial and deep veins) back into the deep system. This is assisted by a one-way valve that prevents back flow of blood. An interesting difference exists between deep venous insufficiency and superficial venous insufficiency.

Deep venous insufficiency (usually the result of a blood clot obstructing the deeper veins) occurs when a person’s deep vein valves are damaged — too weak to react in time to prevent back flow of blood. That puts tremendous pressure, which could lead to venous stasis (loss of proper vein function of the legs that would normally carry blood back toward the heart). This may occur following injury to the veins, which can result in blood clots in the deep veins known as deep venous thrombosis and venous edemas in a person’s lower extremities.

Superficial venous insufficiency is more common, though. In this circumstance, the deep veins function normally, but that important venous blood, instead of flowing through the deep vein system, flows in the wrong direction through exhausted, over-dilated superficial veins. The veins’ weak valves cannot handle the pressure.

So how do you know if you have chronic venous insufficiency or any kind of venous stasis or vascular disease? Here are the symptoms: First, your limbs and skin might itch so furiously that no amount of scratching ever satiates the horrible, prickly agitation. Skin in the affected area turns thick and scaly — sometimes flaking into eczema. Whatever color your skin is normally, it changes to startling hues of deep red and purple then eventually to black.

Also, your legs, when besieged by poor circulation, might cause varicose veins, venous stasis pigmentation, and skin ulcers.

Weepy ulcers, mired in venostasis, can easily get infected. Also, this lower extremity venous disease puffs out the venous veins into lumps of swollen leg edemas.

Do leg ulcers and venous ulcers become chronic?

Venous stasis ulcer is a serious condition. Here are some of the basic treatment strategies:

• Avoid long periods of standing or sitting. If you must take a long trip and will be sitting for a long time, flex and extend your legs, feet, and ankles about 10 times every 30 minutes to keep the blood flowing in the leg veins. If you need to stand for long periods of time, take frequent breaks to sit down and elevate your feet.
• Exercise regularly.Walking is especially beneficial.
• If you’re overweight, try to lose weight.
• Elevate your legswhile sitting and lying down. Raise your legs above the level of your heart.
• Avoid smoking, alcohol, caffeinated products, oral contraceptives or hormone therapy.
• Wear compression stockings to compress your lower leg so the diseased, leaky valves will close properly.
• Take antibiotics as needed to treat skin infections.
• Practice good skin hygiene.

The goals of treatment are to reduce the pooling of blood and prevent leg ulcers. In the case of Martin, I did sclerotherapy and gave him compression stockings together with maintenance medications to prevent the recurrence of varicose veins.