This year (May 2023) Minnesota Vein Center participated as a sponsor for the 3rd Annual Golfing Fundraiser for the non-profit organization, Survival2Strength. The event featured a fun 9-hole scramble golfing tournament with prizes. Survival2Strength is a free program with a focus on strength training, coordination, and mobility. They help people who have or had cancer and cancer related lymphedema become healthy as possible through strength training.

Individuals who undergo major orthopedic surgery such as total hip and total knee arthroplasties, are at risk of developing blood clots in the operated leg for at least 3-months after the surgery.  Factors related to the surgery that may contribute to the development of blood clots include injury to leg veins during surgery, inflammation in the surgery site, and immobility after the surgery resulting in blood pooling in the veins.  Acquired factors such as age, chronic kidney disease, and heavy smoking may also contribute.  Blood clots occur in approximately 1-2% of orthopedic surgery patients who do not have a blood clotting disorder.

Blood Clotting Disorders

Approximately 5-8% of people in the United States have an inherited medical condition called thrombophilia.  Thrombophilia is a blood disorder that increases an individual’s baseline risk of developing blood clots.  This is of particular concern for individuals with thrombophilia who undergo orthopedic surgery because surgery can increase the risk of developing blood clots even more.  Types of inherited thrombophilia include:

• Factor V Leiden thrombophilia (the most common type).
• Prothrombin thrombophilia (second most common type).
• Hereditary antithrombin deficiency.
• Homocystinuria.
• Protein C deficiency.
• Protein S deficiency.

Thrombophilia may also be acquired as a result of damage to the liver or the kidneys.  These two organs help control how blood clots.  The damage may result from an illness like cancer, a physical injury, or exposure to toxic chemicals.  The most commonly acquired thrombophilia is called antiphospholipid syndrome.

Thrombophilia and Orthopedic Surgery

Medical researchers in the Netherlands reviewed the medical records of thousands of patients to determine how frequently blood clots developed after various orthopedic surgeries in both patients with and without thrombophilia.  The researchers found that:

• Patients with thrombophilia had a 4x greater risk of developing blood clots than normal patients, even before surgery.
• Orthopedic surgery created a 6x greater risk of developing blood clots in normal patients.
• Orthopedic surgery created a 13x greater risk of developing blood clots in patients with thrombophilia than patients without thrombophilia and who did not have surgery.

 Overall, patients with thrombophilia had a 3.5% risk of developing blood clots for at least one year after the operation, compared to a 1-2% risk in individuals without thrombophilia.  The greatest risk of blood clots was in the first three months after surgery.  Interestingly, knee surgeries had the greatest risk of developing blood clots in patients with thrombophilia.  It’s not known for sure why thrombophilia increases the risk of blood clots after orthopedic surgery.  It has been proposed that postoperative inflammation at the surgical site stimulates blood cells known as platelets, which help form clots, to clump together more easily.  Surgery in individuals with thrombophilia may also disrupt the balance between mechanisms in the bloodstream that cause clots to form, and to dissolve, causing a shift toward forming blood clots.

Final Words

Current strategies to prevent blood clots in individuals both with and without thrombophilia undergoing orthopedic surgery include blood thinning drugs, highly efficient and minimally invasive surgical techniques, reduced operation time, and early post-operative mobilization.  However, individuals with thrombophilia are at a higher than normal risk of developing blood clots.  Thrombophilia is a serious and complex medical condition that can complicate recovery from surgery.  Individuals with thrombophilia who will be having orthopedic surgery may greatly benefit from a consultation with a Vascular Medicine specialist to develop personalized, pre- and post-surgical strategies for preventing blood clots.

Deep venous thromboses (blood clots) form in the deep veins of the legs in approximately 1-in-1000 people in the United States.  Anyone can develop a blood clot, however, there are known risk factors that increase the chances.  In addition, having more than one risk factor at a time increases the chances even more.  Risk factors include:

• Age.
• Obesity.
• Injury or trauma to the legs.
• Surgery to the abdomen, pelvis, hip or legs.
• Immobility.
• Congestive heart failure.
• Chronic obstructive pulmonary disease.
• Chronic kidney or liver disease.
• Cancer.
• Increased estrogen from birth control pills or hormone replacement therapy.
• Inherited blood clotting disorders.

However, another risk factor for blood clots not often mentioned is rheumatoid arthritis (RA).  Rheumatoid arthritis is a chronic, inflammatory disorder in which the immune system mistakenly attacks joints and other tissues of the body including skin, eyes, heart, lungs, kidneys, nerves, and blood vessels.  A large clinical study in the United States looked at the risk of developing blood clots in two groups of patients.  The first group of patients were newly diagnosed with RA and had not had a blood clot prior to the study.  The second group of patients (control group) did not have RA, and also had never previously had a blood clot.  The objective of the study was to determine if the patients with RA were more likely to eventually develop blood clots.  The patients in each group were matched for age, sex, and pre-existing risk factors for developing blood clots (like those noted above).  The researchers found that the patients with RA had a 40% greater risk of developing blood clots than the patients in the control group.

The chronic, systemic inflammation associated with RA initiates many complex events in the blood that promote the formation of blood clots, even when there is no injury or need for a clot.  One of the body’s abnormal coagulation responses is to increase production of a blood protein called fibrinogen.  Fibrinogen is converted by an enzyme in the blood called thrombin, into another protein called fibrin.  Fibrin binds plasma proteins and platelets together to form blood clots.  Increasing the level of fibrinogen in the blood increases the risk of forming blood clots.

But, the effects of chronic inflammation are even more complex.  Under normal circumstances, the body has strong, natural mechanisms that prevent blood clots from forming when they’re not needed.  Endothelial cells that line blood vessel walls normally interact with blood proteins to produce natural anticoagulant substances that prevent blood clots from forming.  Damage to the endothelial cells by chronic inflammation inhibits their interactions with the proteins resulting in reduced activity of the natural anticoagulants in the blood, and thereby also increase the risk of blood clots forming.

Final Words

Blood clots can permanently damage leg veins resulting in circulation issues, and also create a potentially life threatening condition if part of the clot travels to the lung (pulmonary embolus).  Rheumatoid arthritis is a risk factor for developing blood clots in the legs.  The chronic inflammation of RA alters many mechanisms in the blood stream that control the formation of blood clots, ultimately shifting the balance toward increasing the risk of clot formation.  Patients with RA and at least one additional risk factor should talk with their medical provider about their personal risk for developing blood clots, and strategies to prevent possible physical damage and functional impairment.

Minnesota Vein Center was featured in a Woodbury Magazine article about the opening of the new Woodbury Clinic in July 2022.

Read the full article here: Woodbury Magazine

  Fall is a great time to hit the trail for a hike or bike ride. If you've been putting off getting your legs examined due to concerns over the coronavirus, now is also a great time for a complimentary vein screening. On November 6, 2020, we are hosting our Fall Complimentary Vein Screening. Our office follows all CDC and MDH guidelines for keeping our patients and staff safe. Call 651-765-8346  to schedule a 20-minute exam on November 6 or simply complete the form below with your preferred time and we'll contact you with availability. Screening includes a brief history, exam,  modified venous ultrasound, and info. [contact-form-7 id="2409" title="Your Vein Health Contact Form"]

Your body is designed to move.  When you sit too long every day, even a good workout cannot counteract the ill effects.  Most adults in the U.S. sit for nine or ten hours each day.  This may seriously affect your overall health.  When you get enough exercise, your blood sugar, cholesterol and triglycerides are processed properly.  We all know this decreases your risk of obesity and diabetes.  Fatty acids then may tend to clog your cardiac arteries because our  muscles burn less excess fat due to inactivity. According to the American College of Cardiology, women who sit for ten hours each day are much more at risk of developing heart disease than women who sit for five hours or less.  Other problems that may occur are neck pain, shoulder pain, back problems, weak abdominal muscles and hip problems. Long–term standing also causes venous insufficiency or venous disease.  While standing requires 20 percent more energy than sitting, it can cause veins to overwork, causing weakness.  It may also lead to long-term back pain, muscle fatigue and musculoskeletal disorders. Teachers, nurses, hair stylists among many other professions stand for more than five hours each day.  Two hours of standing may cause no problems, but with long periods, problems may arise. Blood, of our lower extremities, needs to flow from the feet back to the heart.  The veins in the legs have small valves that help push blood upward against gravity.  When you sit or stand for long periods, flow becomes blocked and begins to pool in the veins below.  This puts pressure on the veins, causing the valves to weaken. The most common leg and vein problems are varicose veins and spider veins.  While not serious to begin with, they do lead to more serious health issues if left untreated.  Prolonged sitting and standing place excessive pressure on your legs, causing veins to stop working properly.  The medical term for this condition is venous insufficiency. According a recent Human Factors article, the strain on the legs and veins from standing too long is often not perceived immediately.  This could be avoided if those in ‘long-standing’ professions were able to take regular breaks from standing throughout the day. For those beginning to develop vein problems, you may have symptoms before the bluish, bulging veins start to show.   Common symptoms include:

• A heavy feeling in the lower legs
• Muscle aching and cramping
• Pain that increases after sitting or standing for long periods
• Itching for no apparent reason around on or more vein
• Ulcers or sores that erupt near the ankle and lower leg
• Brown pigmentation on the feet and lower leg
• A rash around the ankles

For you teachers, and others in positions requiring standing long periods, compression stockings can help promote healthy blood flow back to the heart.  While more difficult, alternating weight bearing from leg to leg, intermittent ankle flexing and even short periods of ankle/lower leg elevation may help control damage to vein valves. At Minnesota Vein Center, Dr. Kalsi will  offer the full realm of the non-invasive treatments available for varicose veins, venous insufficiency and spider veins.  You may be asked to wear compression stockings, elevate your feet when sitting and to get regular exercise.  During a consultation with our specialist, you may have your veins evaluated, condition diagnosed and treatment may be recommended.  Contact us today to schedule your appointment to learn more and to visit us.

Update:  Due to the April 13, 2020 Extended Emergency  Executive Order 20-35  from Governor Walz , all MVC scheduled visits and procedures have  been postponed through mid May 2020.   Minnesota Vein Center will remain closed through May 15th.  All scheduled patients will be notified upon the the discontinuation of this order for the purpose of rescheduling. You may call 651-765-8346 if you have an urgent concern or if you need to leave a message.  Please watch this site for updates and for information regarding the schedule for upcoming months.