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Family Medicine (Expert Forum)
Venous Insufficiency?
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Venous Insufficiency?
by jesjes, Aug 26, 2005 12:00AM
I am a 44 year old male, slender, active, never smoked and don't drink. I have no family history of venous disorders.
A little over a year ago I began having aching pains in my perineum and developed red burning skin on my scrotum. Over the following 6 months the pain grew to involve most of my buttocks, the backs of my legs, genitals and burning/stinging pains in my legs & feet. After seeing urologists, dermatologists, neurologist, multiple antibiotics, mri's, ct scans, and nerve conduction studies, the only test with results of any interest was a vasucular study showing some reflux in the greater sapheneous vein. Arteries looked great.
The pain in my perineum, buttocks, groin is worse at the end of the day, made worse by sitting. By the end of the week I can hardly sit. Several times per week I get a brief but very intense localized burning/stabbing pain in my left quadricep. When my other sypmtoms are bad, I have occassional pains in the area of my kidneys. With lots of lower body elevation I feel better by the morning. Active weekends are much better than days in the office.
Vascular surgeons say that I probably have some minor peripheral vascular insufficiency but that probably isn't the cause of my pain. They look at my legs and say it's not that bad. All the branches of the sapheneous veins are visible in my lower legs and tops of my feet. My family doctor thinks it's vascular insufficiency and subsequent pelvic congestion. He says there's nothing I can do about it (except stockings)so I need to start modifying my lifestyle. At my insistence he's going to order and MRI Venograph (MRV). I do believe that the pelvic discomfort could be venous and the red burning scrotum could be from associated poor circulation/drainage.
It's been a long year, but I'm not ready to give up. The reading I've been able to do suggests that problems from venous insufficiency is rare in someone my age & health. It also suggests that if properly diagnosed there are in some cases treatment options such as vein removal or valve repair. Until I can get someone to recognize the problem, and get to the right medical professional/facility I can't even get a firm diagnosis.
What do you think? Am I a candidate for a vein center? Can you recommend a course of action?
Thanks,
John.
A little over a year ago I began having aching pains in my perineum and developed red burning skin on my scrotum. Over the following 6 months the pain grew to involve most of my buttocks, the backs of my legs, genitals and burning/stinging pains in my legs & feet. After seeing urologists, dermatologists, neurologist, multiple antibiotics, mri's, ct scans, and nerve conduction studies, the only test with results of any interest was a vasucular study showing some reflux in the greater sapheneous vein. Arteries looked great.
The pain in my perineum, buttocks, groin is worse at the end of the day, made worse by sitting. By the end of the week I can hardly sit. Several times per week I get a brief but very intense localized burning/stabbing pain in my left quadricep. When my other sypmtoms are bad, I have occassional pains in the area of my kidneys. With lots of lower body elevation I feel better by the morning. Active weekends are much better than days in the office.
Vascular surgeons say that I probably have some minor peripheral vascular insufficiency but that probably isn't the cause of my pain. They look at my legs and say it's not that bad. All the branches of the sapheneous veins are visible in my lower legs and tops of my feet. My family doctor thinks it's vascular insufficiency and subsequent pelvic congestion. He says there's nothing I can do about it (except stockings)so I need to start modifying my lifestyle. At my insistence he's going to order and MRI Venograph (MRV). I do believe that the pelvic discomfort could be venous and the red burning scrotum could be from associated poor circulation/drainage.
It's been a long year, but I'm not ready to give up. The reading I've been able to do suggests that problems from venous insufficiency is rare in someone my age & health. It also suggests that if properly diagnosed there are in some cases treatment options such as vein removal or valve repair. Until I can get someone to recognize the problem, and get to the right medical professional/facility I can't even get a firm diagnosis.
What do you think? Am I a candidate for a vein center? Can you recommend a course of action?
Thanks,
John.
Doctor's Answer
by Kevin Pho, MD, Aug 27, 2005 12:00AM
, Aug 27, 2005 12:00AM
Difficult to say without examination. Although possible, it is atypical for venous insufficiency to cause such symptoms. The MRV can help elucidate this cause.
A neurological problem (i.e. spinal stenosis) may be a more likely scenario. However, you have already had MRIs and nerve conduction studies. I would assume that an MRI of the lumbar spine was considered to evaluate this condition. A neurological second opinion can be considered.
Other tests to consider to evaluate the vascular system would be a duplex ultrasound as well as measurement of the arterial-brachial index. The latter test can look for concurrent arterial disease.
As for consideration of a vein center - this can be decided after the results of the MRV and other vascular testing.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
A neurological problem (i.e. spinal stenosis) may be a more likely scenario. However, you have already had MRIs and nerve conduction studies. I would assume that an MRI of the lumbar spine was considered to evaluate this condition. A neurological second opinion can be considered.
Other tests to consider to evaluate the vascular system would be a duplex ultrasound as well as measurement of the arterial-brachial index. The latter test can look for concurrent arterial disease.
As for consideration of a vein center - this can be decided after the results of the MRV and other vascular testing.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
