Chronic venous insufficiency: What to know
Venous insufficiency is fairly common. According to the Society for Vascular Surgery, it affects up to 40 percent of people in the United States.
It is also usually chronic. This condition causes leg and foot swelling, varicose veins, and aching legs.
In this article, we cover the causes and risk factors for venous insufficiency, as well as how to diagnose and treat it.
What is venous insufficiency?
Symptoms of venous insufficiency can include dull aching and swelling in the legs and blood clots.
The heart pumps oxygen-rich blood through the arteries to the rest of the body, while the veins bring deoxygenated blood back to the heart.
When a person has venous insufficiency, their veins have trouble moving deoxygenated blood from the arms and legs back to the heart. Faulty valves inside the veins usually cause venous insufficiency.
Veins have valves made up of two flaps, which prevent the backward flow of blood. These are called bicuspid valves. If the veins are damaged or become dilated, the valves may fail to close properly.
When the valves do not work properly, blood will flow back into the veins instead of forward to the heart. This causes blood to pool in the veins, often in the legs and feet.
This results in many of the symptoms associated with venous insufficiency, such as skin discoloration, swelling, and pain.
Some of the symptoms of venous insufficiency include:
- heaviness, throbbing, or dull aching in the legs
- swelling of the legs and ankles
- cramping or itching in the legs
- patches of darker, brownish skin
- thicker or harder skin on the legs or ankles
- open sores
- blood clots
- varicose veins
Causes and risk factors
Varicose veins can cause venous insufficiency.
The following factors are more likely to cause venous insufficiency:
- having a family history of the condition
- having blood clots
- having varicose veins
- being pregnant
- having obesity
- having phlebitis, or swelling of superficial veins
- sitting or standing for long periods of time
The best treatment for chronic venous insufficiency will vary from person to person. Doctors must consider several factors before deciding on the best treatment course.
Some of these factors include the cause and symptoms of venous insufficiency and the age and health status of the person.
Treatments for chronic venous insufficiency include the following:
Healthcare provides may prescribe medications that improve blood flow through the vessels. Some medications that can help treat venous insufficiency include:
- diuretics, which are medications that remove excess fluid from the body
- pentoxifylline, which reduces inflammation and improves blood flow
- blood thinners, or anticoagulants, which prevent blood clots
People can reduce the symptoms of venous insufficiency at home using the following methods:
- Wearing compression stockings. These are special elastic stockings that apply pressure to the lower leg and foot. Compression stockings help reduce swelling and improve blood flow.
- Elevating the legs above the heart. This helps pull blood from the legs toward the heart
- Practicing good skin hygiene. People with venous insufficiency can develop skin problem, such as dermatitis, cellulitis, or atrophie blanche (white atrophy).
People with venous insufficiency can take care of their skin using the following methods:
- keeping it moisturized so that it does not become dry or flaky
- exfoliating regularly to remove dead skin cells
- applying topical ointments as their healthcare provider instructs
The following nonsurgical methods can help treat venous insufficiency:
In some cases, doctors will recommend destroying damaged veins in a process called ablation. They destroy the veins by applying either heat or chemicals.
In sclerotherapy, a doctor will inject a liquid or foam solution into the damaged vein. The vein reacts to the solution and swells shut. Then, the body absorbs the vein and redirects blood to other healthy veins.
A phlebectomy is a minimally invasive procedure in which a medical professional removes varicose veins through small punctures in the skin.
Laser therapy is a relatively new procedure in which a doctor uses lasers to close damaged veins.
People with serious cases of venous insufficiency may require surgery. Some surgical procedures that treat venous insufficiency include:
- repairing damaged veins or valves
- stripping or removing damaged veins
- implanting a small mesh tube, called a stent, to widen the vein
- ligation, in which a doctor ties off veins through a small incision in the skin
Types of venous insufficiency
Chronic venous insufficiency falls into three different categories depending on the severity of the symptoms.
- Stage 1. Swelling and changes in skin pigmentation characterize this stage.
- Stage 2. Swelling, changes in skin pigmentation, and dermatitis characterize this stage.
- Stage 3. Swelling, changes in skin pigmentation, varicose veins, and ulcers characterize this stage.
Venous insufficiency can cause chronic venous hypertension, a condition characterized by high blood pressure in the veins of the legs. Blood clots or other blockages in the veins can also lead to this condition.
If left untreated, chronic venous hypertension can cause abnormalities in the capillaries within the leg tissues, resulting in ulceration, swelling, and hyperpigmentation. This is a condition in which patches of skin become darker than usual.
A doctor may request an MRI scan to diagnose venous insufficiency.
A physical examination is the first step toward diagnosing venous insufficiency. A doctor will also review a person's medical history and current health status before making a diagnosis.
Diagnostic procedures that help determine whether or not a person has venous insufficiency include:
- Venogram. This examination uses X-ray technology to examine how blood flows through the veins. It requires injecting contrast material into a vein. Healthcare providers uses venograms to locate blood clots and evaluate varicose veins.
- Duplex ultrasound. This noninvasive test examines the speed and direction of blood flow through the veins and arteries.
Additional medical tests for venous insufficiency can include:
Many of the risk factors associated with venous insufficiency are related to a person's lifestyle. People can reduce their risk of developing venous insufficiency by making small lifestyle adjustments, such as:
- getting regular exercise
- avoiding wearing high heels
- avoiding standing or sitting for long periods of time
- maintaining a healthy body weight
Venous insufficiency is common condition in which the blood does not flow smoothly through the veins and back to the heart. This is due to faulty valves in the veins.
Venous insufficiency is a common condition. It is not life-threatening, but it is usually chronic.
Symptoms of venous insufficiency include varicose veins, swelling, and heavy, aching legs.
Left untreated, venous insufficiency can lead to other health conditions, such as dermatitis, venous ulceration, and chronic venous hypertension.
Treatment of venous insufficiency varies depending on the severity of the symptoms, the individual's medical history and current health status, and the cause of the condition.
Treatments for venous insufficiency focus on managing symptoms and preventing further complications. Those who have had venous insufficiency require ongoing care even after successful treatment, as the condition often reappears.