Leg problems such as swelling and discoloration affect many people worldwide, and peripheral vascular disease (PVD) is one of the primary causes. What are these things, and what can you do about them?
What Are Leg Discoloration and Leg Swelling?
What Are the Causes of Leg Discoloration and Edema?
Vascular disease manifests in many ways. However, leg edema and discoloration are two primary symptoms.
Discoloration and edema (swelling) can involve problems with blood circulation in your legs which may include venous disease and/or lymphedema. The drainage of blood back to the heart is provided by the lymphatic systems and the veins in the legs. The lymphatic system filters clear fluid(lymph) that is outside of the veins back into the venous system to be carries back to the heart.
Another term for leg swelling is "leaky legs." When you have certain vascular disease types, your legs may swell, starting at the ankles and spreading up your legs, particularly if you don't seek medical attention as soon as possible. If you have chronic leg swelling, you might have a problem with return blood flow in your veins, resulting in blood accumulating in your legs. In either case, leg swelling can cause pain and discomfort and lead to severe complications.
In cases of vein disease, venous insufficiency, the blood does not drain properly through the veins back to the heart. Venous insufficiency can be a result of poor drainage from the superficial veins or from obstruction preventing proper drainage from the deep veins. The pooling of blood due to improper drainage causes pressure to increase in the veins and fluid is then pushed out of the veins into the tissues under the skin which creates swelling. This increase in pressure can also put additional strain on the lymphatic system. Edema most often occurs in the lower part of the leg(s) or around the ankle(s). In most cases the swelling is worse on one side compared to the other. The swelling will typically increase with periods of long standing or sitting and often improves with leg elevation.
In cases where the lymphatic system is involved, patients may be diagnosed with lymphedema. Lymphedema can involve swelling down into the foot and become quite severe. The edema may persist even with leg elevation. Lymphedema and venous disease often happen together in a disease process known as phlebolymphedema. This occurs when the pressure inside the veins becomes elevated due to pooling of blood(venous hypertension) and does not allow lymph fluid to drain from the lymphatic system.
Other causes of swelling and discoloration may include increased salt intake in the diet, side effects from medications, previous surgeries, hormonal imbalance and organ dysfunction. Swelling also worsens during times of warmer weather. These should be evaluated for along with evaluation for venous disease.
You might have one, or more, of any number of conditions causing leg discoloration. Skin disorders, Addison's Disease, and others can all cause discoloration.
In cases of venous insufficiency and/or lymphedema, the exposure of the skin and underlying tissues(subcutaneous tissue) to blood products in the fluid that causes swelling can lead to a darkening in pigmentation or staining of the skin. The discoloration typically appears in the lower legs or around the ankles. Other skin changes may be noticed as well such as an appearance of thickening of the skin. In patients with chronic skin changes we may see a deterioration of the subcutaneous tissue due to damage caused by these blood products(lipodermatosclerosis). Ultimately the damage and constant pressure from inside the skin tissues may lead to open wounds or ulcerations.
However, when it comes to vascular disease, things like hardening and narrowing of the arteries cause circulatory problems in your extremities, leading to discoloration.
Leg Discoloration Caused by a Vascular Disorder
You might think that leg discoloration means a rash that looks like broken capillaries or little spider veins. The truth is that vascular disorders that cause leg discoloration present as a general red or blue color and skin that's thin and shiny, rather than tiny spider veins.
Remember that vascular disease might look like other conditions, so see your doctor if you notice discoloration in your legs.
Leg Swelling Caused by a Vascular Disorder
Leg swelling is a more common symptom of vascular disorder. Your legs swell when your capillaries' pressure is higher than the pressure of surrounding fluids, particularly lymphatic fluids.
Step-by-Step Guide on How to Treat Leg Discoloration and Swelling (As They Relate to Vascular Disease)
How do you treat leg discoloration and edema as they relate to vascular disease?
Doctors use several ways to diagnose vascular disease that causes leg discoloration and swelling. They include:
- Evaluation which includes complete review of the following
- Presenting symptoms
- Primary medical and surgical history
- Review of Medications
- Venous doppler studies to evaluate for venous insufficiency in both the superficial and deep vein system
- Doppler ultrasound flow studies
- Magnetic resonance angiography
- Ankle-brachial index
- Segmental blood pressure measurements
- Exercise tests
Each one of these tests gives your doctor a picture of what the circulation in your legs looks like. From there, they can develop the best treatment options for your particular condition.
Once your doctor has a diagnosis for you, they can develop treatment plans that address your particular condition. However, treatment doesn't only depend on your situation. Other factors affecting treatment include:
- Your age
- Your health and medical history
- How severe your condition is and how it affects your lifestyle
- Other medical condition and how sick you are overall
- Your tolerance for specific medications, therapies, and procedures
- How long your doctor believes your condition will persist
- Your personal preferences and opinions
Conservative management of swelling may include the following recommendations
- Leg elevation during periods of rest. Gravity will cause an increase in pooling of blood in the lower legs and increase swelling if the legs are left dangling rather than elevating them
- Compression stockings. These are special style socks or stockings which apply different amounts of pressure at varying levels. This pressure gives the veins support to limit the amount of pooling of blood. They come in a variety of styles and sizes and are meant to be worn during extended periods of sitting or standing
- Close monitoring and management of other medical conditions that may lead to swelling
- Limit salt/sodium intake in the diet
- Adjustment of medications that may be contributing to swelling
Treatment of venous disease
- Most treatment of venous disease involves minimally invasive processes which may include the following
- Ablation or closure of the superficial veins with the use of specialized radiofrequency or laser catheters or with injection of medication directly into the malfunctioning vein(s)
- Treatment of the deep veins may include venograms, Intravascular Ultrasound(IVUS), venoplasty and stent placement
Treatment for Lymphedema
- Evaluation with a lymphedema specialist may be recommended. A lymphedema specialist is trained in specific massage therapy and/or compression therapy to help drain fluid from the tissue back into the lymphatic and circulatory system.
- Lymphedema pumps may be prescribed for use at home. Lymphedema pumps or pneumatic compression devices allow for the convenience of use in the home on a daily basis. The pumps provide intermittent compression at different levels of the legs to push fluid out of the tissues back into the lymphatic and circulatory system.
There are some reasonably standard treatments for vascular disease that causes edema and discoloration, though:
- Changes to your lifestyle to reduce or eliminate external risk factors
- Addressing and treating underlying conditions like diabetes, high blood pressure, and high cholesterol and obesity
- Medication adjustments
- Vascular bypass surgery
Treatment of Leg Swelling During Pregnancy vs. Vascular Disease
Pregnant women may experience leg swelling that has nothing to do with vascular disease. Pregnancy causes your body to retain more fluid, which naturally leads to swelling in certain tissues and areas of your body. Elevation of blood pressure(pre-eclampsia) may also occur which can make swelling worse.
Also, your uterus gets bigger as your baby grows. That creates more pressure on your veins, which can restrict blood from draining out of the legs increasing pressure in the veins.
Treatment for leg swelling during pregnancy is vastly different from treatments for vascular disease, which includes:
- Staying off your feet as much as possible with elevation of the legs when not doing light exercise, like walking
- Wearing compression stockings to prevent blood accumulation in your legs
- Sleeping on your left side
- Other than compression stockings, wearing loose clothing
- Limiting salt and sodium intake in your diet
- Close monitoring of your blood pressure during pregnancy
Foot massages may also help reduce leg swelling during pregnancy.
The Gold Standard Treatment
Generally, treatment includes a combination of reducing risk factors and administering medication. People with vascular disease initially have no symptoms, which is why screening is so important.
Whether you're symptomatic or not, once your doctor diagnoses you, they will likely recommend the following treatment regimen to maximize each method's benefits and give you the best chance of mitigating your condition.
- Identify and treat all risk factors, including smoking, weight, activity level, diet, etc.
- Administer blood thinners, cholesterol medications, and blood-pressure medications
- Walking or light cardiovascular exercise for at least 30 minutes a day, three times a week
- Help with smoking cessation
- Foot care advice
- Dietary advice
- Follow-up care and monitoring with your primary care doctor
If you need surgery, your doctor will recommend that, too, and help you set it up. However, surgery comes with risks, so your doctor may not recommend it as a primary treatment.
Once you begin treatment for leg discoloration or swelling due to vascular disease, what can you expect? Will you get better? Will your symptoms go away?
Treatment plan will be based on degree of symptoms and underlying disease process. It is important to maintain compliance with recommended treatments to obtain maximum results. Swelling and discoloration can be chronic symptoms and may take several months to see optimal results.
In many cases of discoloration may be permanent to some degree. Adherence to your treatment plan will help to make sure reduction of discoloration is optimized. Keeping the skin well moisturized to avoid cracking and open areas is advised. You may be prescribed or recommended specific creams to assist with this.
Although you may not have complete resolution of the skin discoloration or swelling, compliance with treatment measures will assist in worsening of these symptoms and reduce the risk of progression to development of open wounds or ulcers
Your prognosis depends on how early your doctor diagnoses your condition, your immediate treatment needs, and how strictly you stick to your treatment plan. Treatment can reduce or eliminate your symptoms and help you manage your condition, which prolongs your quality of life and reduces your risk of serious complications.
However, many patients' prognoses are worse with this type of vascular disease than coronary artery disease. One reason for that may have to do with patients suffering from certain kinds of vascular disease receiving less medication and overall treatment than patients with coronary artery disease.
That doesn't mean you shouldn't seek treatment. Without treatment, your prognosis is much worse.
As with many conditions, prevention is the best cure. If you have any risk factors that you can address on your own, such as many of those listed above, your risk of developing the types of vascular disease that cause leg swelling and leg discoloration can fall dramatically.
Common Medications to Expect During Your Treatment Period
Patients may be prescribed diuretics or “fluid pills” to help reduce swelling. While these medications will help to reduce the amount of fluid in the system and may reduce swelling, it is not an optimal long term treatment for underlying venous insufficiency or lymphedema.
Topical creams or ointments may be prescribed or recommended to treat dryness of the skin, skin discoloration or irritation of the skin.
The most common medication for leg discoloration and swelling due to vascular disease involves blood thinners. One of the most significant vascular disease issues is clotting, and those clots can block entire blood vessels.
Also, high cholesterol and blood pressure contribute to vascular disease that results in edema and discoloration in your legs. Because of that, your doctor may also prescribe statins to lower your cholesterol levels and blood pressure medications, too.
What Happens If You Don't Treat Prolonged Leg Discoloration or Swelling?
Untreated swelling and discoloration can lead to progression of chronic skin changes which can put you at risk for cellulitis and/or open skin sores or ulcerations
If you have clots, they can break apart and travel to your lungs, heart, or brain, causing pulmonary embolisms, heart attacks, and strokes. Once any of these happen, your ability to mitigate your condition decreases dramatically.
You can also suffer tissue damage and death, resulting in gangrene. At this point, you'll need amputation because the tissue death will only spread.
Managing Leg Swelling and Discoloration After Treatment
Long term management of swelling and discoloration may include the following
- Ongoing use of compression devices(stockings, lymphedema pump, wraps, etc)
- Leg elevation
- Routine exercise regimen
- Maintenance of BMI of <30
- Close monitoring and management of other medical conditions
- Reduced salt/sodium intake in the diet
During and after treatment, you need to find ways to manage your condition to reduce your risk of having your symptoms return. Those include:
- Getting regular exercise, even if it's just walking
- Eat healthier foods, including fruits and vegetables
- Try and maintain a healthy weight for your body's build
- Follow your doctor's advice if you have conditions like diabetes
- Maintain healthy blood pressure and cholesterol levels
- Take all medication as prescribed
- Visit your doctor regularly
What to expect after treatment from CVM?
At the Center for Vascular Medicine, our mission is to help patients with their vascular diseases in a cost-effective and compassionate manner. We specialize in the diagnosis and treatment of venous and arterial diseases in the legs, feet, and pelvis. Our world-class providers are the most experienced in the specialty and work with patients to develop a treatment plan that is custom tailored to their unique situation.
Typically, this process involves an initial consultation and ultrasound scan at one of our accredited facilities. After reviewing the results of your scan and obtaining a thorough medical history, our providers will discuss the results with you and help you decide on next steps.
Our health care providers use several diagnostic tests to help determine what vascular diseases may be causing your symptoms. Our initial evaluations utilize ultrasound because this non-invasive imaging modality helps us verify our suspicions on whether your symptoms are caused by underlying vascular disease.
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