Doc: Veins in leg can adapt to blood flow

Dear Dr. Roach: If two of the major veins in your leg were removed, what would happen to the blood flow? Would you get enough to your heart and brain?

Anon.

Dear Anon.: The veins of the body return blood to the heart. There are many veins in the limbs, so blood has many routes it can take. Moreover, the body has the ability to increase the size and capacity of veins, so if one vein is damaged or surgically removed, the others increase their size and flow capacity.

This is the reasoning behind a treatment for a common chronic problem: venous insufficiency, which is when a vein is not performing adequately at returning blood back to the heart. With venous insufficiency, there often is obvious swelling of the veins (including varicose veins). Its symptoms include leg pain or a feeling of heaviness, swelling and skin changes or ulcers. Initial treatment of venous insufficiency is periodic leg elevation, exercise and compression stockings, but some people will need additional treatment.

One increasingly common treatment is ablation (destruction) of leg veins. This can be done surgically, but new treatments include injection of medications that damage the veins enough that they close.

Heat treatments accomplish the same goal. The heat can be applied from the outside (usually by laser) for superficial veins or internally, by an intravenous catheter that uses radio waves to heat the vein. Ablating the damaged veins forces the blood to flow through other, undamaged vessels, with success rates of greater than 70 percent at 10 years.

Dr. Roach Writes: Many people have written about sleep apnea, and I wanted to bring up some of the treatments I didn’t discuss in my previous column. Some people wrote about their surgeries, including surgery to move the jaw forward and those that remove soft tissue from around the airway. I lack space and expertise for a comprehensive review of these situations.

I also heard from people with an oral appliance, which may be a reasonable choice in people with mild or moderate obstructive sleep apnea.

Email questions to ToYourGoodHealth@med.cornell.edu.