Venous Insufficiency
Chronic venous insufficiency is a fairly common condition that may affect up to 40% of the U.S. population, particularly more common in women with multiple pregnancies. This condition causes worrisome symptoms like leg ulcers due to poor blood flow from the legs to the heart.
What Is Chronic Venous Insufficiency?
Chronic venous insufficiency occurs when the valves within the leg veins malfunction, leading to impaired blood flow. To understand chronic venous insufficiency, it would help to learn how blood vessels, such as the arteries, capillaries and veins function.
- Arteries: Carry oxygen-rich blood away from the heart to nourish organs throughout the body.
- Veins: Transports deoxygenated blood back to the heart.
- Capillaries: Channels through which nutrient and oxygen exchange occurs.
In the arms and legs, veins have built-in one-way valves that prevent blood backflow due to gravity. When these valves do not work as they should, blood accumulates in the legs, exerting pressure on vein walls and causing venous insufficiency, which often recurs (chronic) even with successful treatment. Factors like hereditary valve dysfunction, valve destruction post-deep vein thrombosis and blood clots contribute to reduced circulation.
Common chronic venous insufficiency symptoms may include the following:
- Enlarged and twisted veins in the legs that look "ropy" and are close to the surface of the skin (varicose veins)
- Throbbing pain or feeling of heaviness in the legs
- Leg swelling or edema
- Leg cramps
- Itchy and flaky skin
- Discolored skin below the knees
- Open sore or ulcer that does not heal
These signs and symptoms usually indicate a problem with blood circulation. Consulting a healthcare provider can help determine whether you have chronic venous insufficiency.
If left untreated, chronic venous insufficiency can progress and result in post-phlebitic syndrome, which causes chronic swelling, pain and discoloration of the skin. In severe cases, the skin can break down, allowing an ulcer (open sore) to form. These ulcers are difficult to heal. Chronic venous insufficiency can also lead to severe hemorrhage without proper treatment.
What Is the Best Treatment for Venous Insufficiency?
Chronic venous insufficiency treatment options vary based on factors like severity, underlying causes and the patient's health history. Additionally, specific symptoms, age and tolerance for medications or procedures play a role in determining the appropriate treatment. What may be best for one patient may not be the same for another.
The most common treatment involves prescription compression stockings, which are elastic stockings that apply pressure to the ankle and lower leg. These stockings enhance blood flow and reduce leg swelling. Additionally, certain medications can help manage chronic venous insufficiency:
- Diuretics: Medications that draw excess fluid from your body, which is then excreted through the kidneys
- Anticoagulants: Blood-thinning medications
- Pentoxifylline (Trental): A medication that enhances blood flow
Some venous insufficiency is so severe that surgery may be necessary to help treat the symptoms. These surgical options are:
- Surgical repair of veins and valves
- Vein removal surgery
- Minimally invasive endoscopic surgery: Uses a thin tube with a camera that helps tie off varicose veins.
- Vein bypass: Transplanting a healthy vein from another body part (usually in the upper thigh) as a last resort for severe cases.
- Laser surgery: A newer technique that uses lasers to fade or close damaged veins with precise and strong bursts of light.
Other treatment options for venous insufficiency include:
- Ambulatory phlebectomy: An outpatient procedure involving numbing and pricking specific areas on the leg to remove varicose veins
- Sclerotherapy: A treatment method primarily reserved for advanced venous insufficiency, targeting small to medium veins. In sclerotherapy, a chemical is injected into the damaged vein so it can no longer carry blood. As a result, the blood reroutes through healthier veins, and the damaged vein eventually gets absorbed by the body.
- Catheter procedures: Generally used in severe cases of venous insufficiency. In a catheter procedure, the doctor inserts a thin tube (catheter) into the vein, heats the catheter's end, and then removes it to close and seal the vein as it is withdrawn.
What Causes Venous Insufficiency?
Chronic venous insufficiency can arise from various factors, such as varicose veins, inflammation with or without clots in the veins known as phlebitis, excessive body weight and pregnancy. While some people are born with leaky or dysfunctional valves, others may develop chronic venous insufficiency due to trauma, prolonged standing, hormonal shifts or deep vein thrombosis. It is more prevalent in women, particularly after multiple pregnancies, and tends to affect middle-aged or older adults.
Does Venous Insufficiency Go Away?
Chronic venous insufficiency is a fairly common, usually chronic condition that often recurs even after successful treatment. Patients with chronic venous insufficiency may need further care.
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