Varicose veins, factors for CV must be evaluated before any surgical procedure

Key Points

Editor's note: In this three-part series - which is part of Advanstar Communications' interdisciplinary effort to investigate and address cardiovascular (CV) disease in women - we will look at the potential comorbidities that overweight patients may have, many of which may preclude them from having dermatologic or cosmetic surgery, and how the failure to investigate the CV status of these patients may have catastrophic consequences.

In future installments, we will explore the potential adverse events that patients suffering from CV disease may experience after surgery, as well as the possible impact of the medications that these patients take on the outcome of surgery.

Like the Cardiometabolic Disorders and Weight series that ran in the September, October and November 2009 issues of Dermatology Times, this series is part of Advanstar Communications' Action for Outcomes interdisciplinary healthcare initiative. See http://www.dermatologytimes.com/action4outcomes for more information on this effort and to access the Cardiometabolic Disorders and Weight articles.

As a result, physicians must be wary of these associations, and must take special care when treating patients with VV who concomitantly suffer from CV.

Venous insufficiency

Cardiovascular disease is a constellation of diseases, the most common of which is coronary heart disease, the leading cause of death in the United States.

Other forms of CV disease include stroke, high blood pressure and atherosclerosis.

Though there is no increased association between VV or venous insufficiency and CV disease or coronary heart disease, both VV and CV can lead to life-threatening complications, including deep venous thrombosis and pulmonary embolism, begging the need for a thorough diagnostic work-up prior to any cosmetic procedure.

"Significant venous insufficiency can increase a patient's risk of developing deep venous thrombosis and thrombo-embolism, which could culminate in pulmonary embolism," says Suzan Obagi, M.D., associate professor of dermatology and director of the Cosmetic Surgery and Skin Health Center at the University of Pittsburgh Medical Center, Sewickley, Pa.

"Furthermore, peripheral arterial disease (PAD) of the legs can be a warning that this patient has significant coronary artery disease," she says. "These higher-risk patients should be evaluated more frequently and receive appropriate pharmacological or surgical treatment where necessary."

Venous insufficiency occurs when the valves inside the veins fail, causing an incompetence of the superficial veins. This leads to a pooling of blood within the veins, resulting in high blood pressure within the veins, and this series of events can put patients at risk of suffering complications.

The most obvious physical manifestation of venous insufficiency is VV. Sometimes, though, physicians may miss the diagnosis of venous insufficiency, as it can also present with more subtle symptoms such leg edema, heaviness, aching, burning and an eczematous-like rash, hyperpigmentation or spider veins around the ankle due to the high pressure that is transmitted to that area.

"Spider veins are a cosmetic problem, unless the patient has symptoms or physical exam findings suggesting venous insufficiency," says Colin E. Bailey, M.D., F.A.C.S., at Bailey Vein and Aesthetic Centre, Osage Beach, Mo. "In this scenario, proceeding with sclerotherapy would be inappropriate, as the patient requires a detailed venous duplex ultrasound to identify the source of venous insufficiency, which could be due to pressure issues in the great saphenous system or deeper veins. The venous insufficiency must then be treated first."