Dr Bray provides care for all venous conditions

Venous Thrombosis

Venous thrombosis refers to the formation of a blood clot (thrombus) within a vein.

  • Deep Vein Thrombosis (DVT): Clot in the deep veins.

    Superficial Thrombophlebitis: Clot in a vein close to the skin’s surface, often associated with inflammation.

    Pulmonary Embolism (PE): A complication where a clot in the deep veins travels to the lungs.

  • DVT (Deep Vein Thrombosis)

    • Swelling in one leg (or arm)

    • Pain or tenderness, often starting in the calf

    • Warmth and redness over the affected area

    Pulmonary Embolism (Medical Emergency)

    • Sudden shortness of breath

    • Chest pain (may worsen with deep breathing)

    • Rapid heart rate

    • Dizziness or fainting

    • Coughing up blood

    • Prolonged immobility - (e.g., long flights, bed rest)

    • Recent surgery or injury

    • Cancer and cancer treatments

    • Hormone therapy or birth control pills

    • Pregnancy and postpartum period

    • Family history of clotting disorders

    • Obesity

    • Smoking

  • DVT: Ultrasound, D-dimer blood test, venography (rarely used)

    Pulmonary Embolism: CT pulmonary angiography, V/Q scan, D-dimer test, blood gases

  • Anticoagulants (Blood Thinners): E.g. Heparin, Warfarin, or newer agents (DOACs) Rivaroxaban, Apixaban).

    Thrombolytics: For severe cases, to dissolve clots quickly.

    Compression Stockings: To reduce swelling and prevent post-thrombotic syndrome.

    Inferior Vena Cava (IVC) Filter: In rare cases, to prevent clots from reaching the lungs if anticoagulants are not an option.

    Surgery – open or percutaneous mechanical thrombectomy

    • Move regularly during long periods of sitting or bed rest.

    • Preventative blood thinners (DVT prophylaxis).

    • Pneumatic calf compression devices.

    • Stay hydrated.

    • Wear compression stockings if advised.

    • Follow medical advice after surgery or during hospital stays.

    • Avoid smoking and high dose estrogen.

    • Keep active and control weight.

  • Signs of DVT = See a doctor urgently or present to ED.

    Signs of PE (shortness of breath, chest pain, fainting) CALL AN AMBULANCE IMMEDIATELY.

Venous Incompetence

(Also known as Chronic Venous Insufficiency)

Venous incompetence occurs when the veins in your legs have trouble sending blood back to the heart. This is usually due to damaged or weakened one- way valves within the veins, causing blood to pool in the legs instead of flowing upward.

    • Damaged vein valves (often due to aging, prolonged standing, or previous blood clots)

    • Deep vein thrombosis (DVT)

    • Obesity

    • Pregnancy

    • Lack of physical activity

    • Genetic predisposition

    • Swelling in the legs or ankles

    • Aching, cramping, or a feeling of heaviness

    • Varicose veins (twisted, enlarged veins)

    • Skin changes (discoloration, thickening, rash)

    • Ulcers, especially near the ankles

    • Itching or tingling sensations

    • Physical exam

    • Duplex ultrasound (to check blood flow and valve function)

    • Venography (in some rare cases)

    • Persistent leg swelling or pain

    • Skin ulcers or rash that won’t heal

    • Sudden leg swelling (could indicate a blood clot—seek immediate care)

  • Lifestyle Changes:

    • Regular exercise

    • Elevating the legs

    • Weight management

    • Avoiding long periods of standing or sitting

    Compression Therapy:

    • Wearing compression stockings to improve circulation

    Medications:

    • To manage symptoms like swelling or prevent clots

    Procedures/Surgery:

    • Sclerotherapy: Injection to close off problem veins

    • Endovenous ablation: Using heat (laser) to seal veins

    • Vein stripping: Surgical removal of damaged veins

    • Angioplasty or stenting: In very rare cases where vein compressed

    • Stay active

    • Maintain a healthy weight

    • Avoid sitting or standing still for long periods

    • Elevate your legs regularly

Pelvic Congestion Syndrome (PCS)

It is estimated that up to 40% of women will experience chronic pelvic pain in their lifetime. The causes of chronic pain are varied but can be associated with the presence of ovarian and pelvic varicose veins.

Pelvic Congestion Syndrome is a chronic condition that causes persistent pelvic pain due to varicose veins in the pelvic area. Similar to varicose veins in the legs, the valves in the veins that help return blood to the heart against gravity weaken and don’t close properly.  This allows blood to flow backwards when sitting or standing causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, bladder, vagina, bowel, ovaries and vulva.

While up to 15% of women, generally between the ages of 20 and 50 have varicose veins in the pelvis (this rises to 40% of women who have had 2 or more babies), not all experience symptoms.  The diagnosis is often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins so that the veins no longer bulge with blood as they may do while standing. Many women with Pelvic Congestion Syndrome spend years trying to get an answer as to why they have chronic pelvic pain.

    • Chronic pelvic pain: Dull, aching, or throbbing pain lasting more than 6 months and usually worse on left.

    • Worsening pain: Especially after prolonged standing, sitting, or during/after sexual intercourse. Relieved by lying down or going for a walk/exercise.

    • Left lower back pain with blood in urine – Nutcracker Syndrome

    • Painful periods (dysmenorrhea) – worse than prior to pregnancy

    • Urinary symptoms: Increased frequency or urgency.

    • Atypical Varicose veins: On the buttocks, thighs, vulva, or lower abdomen.

    • Venous insufficiency: Weakened vein walls or valves causing blood to pool.

    • Hormonal factors: High estrogen levels can dilate veins (common during pregnancy).

    • Multiple pregnancies: Increases the risk due to pressure on pelvic veins.

    • Family history of varicose veins

  • PCS can be challenging to diagnose because its symptoms overlap with other conditions. Once other abnormalities have been ruled out by a thorough pelvic examination and ultrasound by your GP/Gynaecologist, your doctor may recommend review by a Vascular Surgeon for a non-invasive pelvic venous duplex ultrasound to evaluate the blood flow in the veins and clinical assessment.

  • Minimally Invasive Ovarian vein embolization:

    An in-hospital day case procedure where the affected dilated veins are sealed, redirecting the blood flow to improve the pain and appearance of varicosities.

  • Seek GP and Gynaecology review in the first instance, with Vascular review if you experience undiagnosed and unresolved:

    • Persistent, dull aching postural pelvic pain lasting more than 6 months that affects your daily activities

    • Pain that worsens after prolonged sitting or standing, pregnancy, menstrual periods or following intercourse.