Variety of treatments available for problem veins

Host Amber Smith: 我是纽约州锡拉丘兹上州医科大学的安布尔·史密斯. This is "HealthLink on Air."

浅静脉疾病是一类广泛的静脉血管疾病，主要影响身体的下肢.

我将和Dr. Anderson Anuforo. 他是上州医科大学的内科总住院医师.

Welcome to "HealthLink on Air," Dr. Anuforo.

Anderson Anuforo, MD: Thank you so much for having me, Amber. It's my pleasure to be here.

Host Amber Smith: 当我们讨论浅静脉疾病时，包括什么?

Anderson Anuforo, MD: So there are a couple conditions that are classified. There's a classification system that's from C1 to C6, 每一种情况都被归类为浅静脉疾病.

所以它的发展通常是这样的，它开始的时候是这样的，他们叫它a ... the medical name is not really important, but it's a very small vein, the smallest vessels, kind of like a star, and it all spreads out from the center, and that's the C-1.

And then it goes on to become a varicose vein. And that is commonly seen, it's deep blue, you see it under the skin, it's bulging, a little tortuous, kind of like veins clumping together. So that's kind of the next stage.

And after that, the leg gets a little bit more swollen. That's what they call venous edema. 所以基本上是腿部肿胀，然后开始变得更变色，颜色更深.

在那之后，如果不采取任何措施，就会出现溃疡. And that's kind of like the last stage.

And sometimes it can get really bad. 血栓形成，基本上是浅静脉中的血块. 我们通常谈论的血栓形成是我们所说的深静脉血栓, or deep vein thrombosis). 比如在长时间的(飞机)飞行后，静脉深处的那种. 在这些病例中，覆盖在皮肤上的浅静脉中有血块.

这是另一类属于浅静脉疾病的情况.

Host Amber Smith: Varicose veins -- I've heard of that. Is that what you just described?

Anderson Anuforo, MD: 静脉曲张是指皮肤下的静脉. 一般来说，你只会看到一条黑线，长长的黑线.

In this case, 曲张静脉呈蛇形，肿胀，然后扩张, and it's more on the lower extremities, the legs and the thighs, because of the pressure. 所以长时间站着的人更容易因为血液的压力而对抗重力.

Host Amber Smith: 我也听说过慢性静脉功能不全.

Does that get dealt with as a superficial venous disease?

Anderson Anuforo, MD: It definitely is. It definitely is. So, if the pressure in the venous system is very high, over time, 因为静脉中有瓣膜，帮助确保血液只向一个方向流动, from the body to the heart, unfortunately, due to certain conditions, a bunch of things could make that happen. 静脉变得无能，所以它们不能正常工作. And so there's a reflux. Blood flow goes backwards. 它不是向心脏前进，而是由于高压而向后移动. 这就是慢性静脉功能不全，瓣膜功能不全.

Host Amber Smith: 正如你所描述的，在我看来，其中一些情况可能很严重. Is that right?

Anderson Anuforo, MD: Oh, yes. Yes, at the early stages, not as serious. But if nothing is done for some people, if there's a need for intervention, and nothing is done, 它会变得相当严重，并显著影响人们的生活质量.

Host Amber Smith: So at the earlier stages, is it considered a cosmetic thing, and if you just take care of it, it won't get worse, necessarily? 或者这不是一种美容疾病，但确实需要治疗?

Anderson Anuforo, MD: 实际上，在早期阶段，它更多的是装点门面. 但是有些问题你会问发现这种情况的病人或个人, like, 他们有导致疾病发展的危险因素吗?

And if they do have those risk factors, 那么他们中的一些人可能需要尽早治疗.

It's very, very prevalent, actually. 全国有数百万人患有此病，并不是每个人都需要接受治疗. 但如果他们确实有发展的危险因素，那么可能需要干预.

Host Amber Smith: So who is at risk for a superficial venous disease?

Anderson Anuforo, MD: 所以我倾向于将其分为可改变的风险因素和不可改变的风险因素.

The non-modifiable ones, I'll start with that, is age. We cannot turn back the hands of time. Female sex tends to be a slightly higher risk. Family history is something you can't change; sometimes we've seen that people who have family history of these varicose veins and venous issues tend to have it appearing in their children. There are some genetic conditions; the names are not important. There are a bunch of names I could start reeling out now, but basically these names, 它们影响浅静脉的结构完整性, 这就增加了患这些疾病的人患浅静脉疾病的风险.

But thankfully, 有许多可修改的，人们可以做一些事情, things like smoking, prolonged standing, prolonged sitting. 如果他们有某些心脏疾病，比如心力衰竭, situations like that, treating those underlying issues will also help. 深静脉血栓也是可以改变的因为有治疗方法. 如果你能治疗它，它可能有助于改善浅表静脉疾病. 研究还发现，它在怀孕期间更常见，所以这是另一个风险因素.

Host Amber Smith: 这里是纽约州推荐最近最火的赌博软件的“健康连线直播”，主持人是安博·史密斯.

I'm talking with Dr. Anderson Anuforo about superficial venous diseases. He's a chief resident in internal medicine at Upstate.

那么这些疾病是如何被诊断出来的呢? Is it usually a primary care provider that notices it, 或者患者是否会出现一些症状，让他们去看医生?

Anderson Anuforo, MD: That's a great question. 有一些与之相关的症状，比如腿肿，腿痛. 有时你可以明显地看到异常的静脉，或者你可以感觉到它. In cases of, like, blood clots in the superficial veins, you can feel it when you touch it, that this is hard, it's not like a regular vein that collapses.

Some people might also have increased pain in their legs, 然后他们可能会向他们的初级保健提供者抱怨. 所以我认为很多这样的病例都是由初级保健提供者发现的.

However, in the more advanced stages, 然后几个不同的子专业开始更多地参与进来, like vascular surgery, wound care and some portion of interventional cardiology. 有些人做肤浅的干预，所以这是重叠的. 所以这是多学科的，但初级保健确实看到了很多这样的情况.

Host Amber Smith: Is there any testing that goes into diagnosing?

Anderson Anuforo, MD: Oh, yes. Oh, yes. So first-line tests would be an ultrasound, 基本上就是浅表静脉的超声波检查, 然后检查血液在浅静脉和深静脉之间的流动情况, 它们通常是通过所谓的穿支静脉连接起来的. 想象一下，一个表面的，一个深层的，然后在两者之间有一座桥梁.

And these are evaluated using ultrasound. And on the ultrasound, you can also check to see flow, 所以你也可以根据静脉回流来诊断慢性静脉功能不全.

So that's first line. 还有一些更高级的东西(测试)，比如核磁共振和ct. 有一种方法叫做容积脉搏描记术，可以测量静脉内的压力. 它更高级，但第一步是超声检查.

Host Amber Smith: 好吧，让我们谈谈现有的治疗方法以及它们的效果.

Is there a gradation? 你是从某件事开始，看看是否有效，然后继续前进吗?

Anderson Anuforo, MD: 这取决于我们治疗的是哪种浅表静脉疾病.

So, like I said, the CEAP, that's the common "clinical, etiological, anatomic and pathophysiology,“这就是分类的名称——基于此, 如果是静脉曲张或网状静脉(可见但小于静脉曲张), the more milder, superficial ones, a lot of times topical creams. 有很多面霜，壬二酸，甲硝唑面霜. There are a couple of creams that work, 你可能不需要任何药物或任何干预措施.

From varicose veins onwards, where you have, like, leg ulcers and all of that, there are other treatment options. Some are systemic: We take it like drugs, medications. So if it's like leg swelling, in that case, 帮助人们小便的水丸可以帮助消肿.

There are some other, they call it medical foods; the trade name is Vasculera. It contains a flavonoid, 哪种化学物质可以帮助改善血管的结构和完整性. And it can be used primarily or as an adjunct.

然后是那些静脉中有血栓的病人, 对于那些血块发展成深静脉血栓的高危人群, a blood clot in the deep veins, or dislodging and going to the lungs, for those patients, 还有一个作用是在短时间内使用血液稀释剂.

从药理学上讲，这是几种治疗方法. 有很多新的干预通常在血管外科或伤口护理或介入性心脏病学领域, as well.

Host Amber Smith: Do compression stockings offer any assistance?

Anderson Anuforo, MD: Oh, they definitely do. That's one of the first-line things, in addition to lifestyle modification, so trying to minimize prolonged standing, prolonged sitting, 压缩袜是第一批帮助消肿的东西, varicose veins, even, like, venous ulcers. Even at pretty much the last stage, 压缩袜仍然是一群病人的一线治疗方法.

Host Amber Smith: 我们讨论过的任何一种情况都可以通过勤奋的治疗来逆转吗?

Anderson Anuforo, MD: Oh, yes. Oh, yes, especially if it's found earlier. 有很多这样的情况需要改变生活方式和治疗, 你可以显著地扭转这一趋势，并帮助防止新趋势的形成. 因为它在一条腿上并不意味着它不能出现在另一条腿上. And so with lifestyle modifications and things like that, 紧箍针袜和坚持任何治疗方案提供的提供者, that might also help reverse the trend.

Host Amber Smith: So that's encouraging.

Anderson Anuforo, MD: Yes.

Host Amber Smith: 你在《推荐最近最火的赌博软件》上发表了一篇关于这个主题的论文, 你还提到了浅表静脉疾病带来的临床和经济负担. What did you mean by that?

Anderson Anuforo, MD: Not really surprisingly, a good number of these cases are actually undiagnosed, because some people see it on their body, 而且他们从不向他们的初级保健提供者提出这个问题, so it's significantly underdiagnosed.

However, for example, like varicose veins, about 150,000 new cases of these are diagnosed every year, 医疗保健费用每年接近5亿美元. And that's just for that.

If we go on to talk about chronic venous insufficiency, 就像不称职的血管，以及它是如何流入数百万，数亿美元的, and possibly even into billions of dollars, 如果我们开始考虑这些疾病是如何影响这些人的生活方式和生产力的.

It can have significant, far-reaching effects.

Host Amber Smith: Do health insurers typically cover care? I mean, if we talk about varicose veins, for instance, 健康保险公司会为某人的静脉护理买单吗?

Anderson Anuforo, MD: So for most of the creams and the medications, oral medications, a good number of that is covered by insurance.

However, when we start getting to the interventional things, 有很多奇特的名字——有热干预，也有非热干预.

So thermal, 基本上，他们用热量燃烧静脉，然后将其闭合, and then that way it's almost like it gets squished, and it doesn't open up anymore, 所以血液被迫流向正常工作的血管而不是不正常的血管. 所以静脉内激光消融，微波，射频，蒸汽都是热疗的选择. 其中一些是不包括在内的，特别是在医疗保险中，所以这对病人来说是一个挑战.

There are other sclerotherapies where we don't use heat. 它们使用不同的化学物质，但也会产生几乎相同的效果.

And it kind of depends. 但其中有些是在保险范围内的，有些则没有.

Host Amber Smith: 听起来有很多选择病人真的需要像你这样的人来引导他们找到对他们的情况有帮助的方法.

Anderson Anuforo, MD: Oh, yes. There are a lot of options out there, and thankfully, there's a lot beyond myself; there are a lot more providers, and it's multidisciplinary. 很多不同专业的人在不同的阶段会看到不同的人. 例如，伤口护理小组也会看到一些患有晚期溃疡的人. 还有人造皮肤移植物质也用于护理浅静脉疾病患者.

But there are definitely options and providers out there, unified, willing to help and provide hope to these patients.

Host Amber Smith: Dr. Anuforo, I appreciate you making time for this interview.

Anderson Anuforo, MD: It was my pleasure.

Host Amber Smith: My guest has been Dr. Anderson Anuforo. 他是上州医科大学的内科总住院医师.

I'm Amber Smith for Upstate's "HealthLink on Air."

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