Venous reflux disease (VRD), also better known as chronic venous insufficiency (CVI), occurs when veins fail to return blood to the heart properly.
The condition most commonly affects the legs. It causes uncomfortable symptoms, such as pain and ulcers, and can worsen without treatment.
This article explores what VRD is, its causes, symptoms, diagnosis, treatments, and how to prevent it.
Arteries deliver oxygenated blood throughout the body, while veins move deoxygenated blood from bodily tissues back to the heart. For this process to occur, veins contain one-way valves that open and close, helping blood flow against gravity towards the heart.
If these valves become damaged and do not fully close, they can allow blood to flow with gravity, causing reflux and impairing blood circulation. Blocked or obstructed veins can also impair blood flow back to the heart.
Venous reflux develops when valves in the saphenous veins become damaged or blocked. These veins run up and down the leg, returning blood from the feet, shins, and thighs to the heart.
When the valves in the saphenous veins are impaired, blood can pool in the leg, foot, or toes. Over time, reflux in veins can also cause them to widen or dilate, becoming thinner and weaker.
Vein conditions are some of the most common chronic health issues in the United States, with around 40% of people experiencing CVI.
Venous diseases, such as CVI, are progressive, meaning they become worse over time, particularly if left untreated.
Any condition that blocks the major leg veins or damages or weakens their valves can cause VRD.
Conditions that can lead to VRD include:
- deep vein thrombosis (DVT)
- vein wall weakness, which causes veins to enlarge to the point where the valves cannot close
- a congenital (from birth) absence of vein valves
- a history of blood clots or DVT in the leg that damages or weakens vein valves
- tumors or unusual growths
- blockages in the veins of the pelvis or groin
Most people inherit genes that make them more likely to develop CVI. The condition may also develop after injury or disease.
People with mild cases of CVI may have no symptoms. However, others with the condition may experience symptoms associated with blood pooling in the legs and the resulting increase in vein pressure.
Those with severe CVI may encounter varying levels of pain and changes to their legs, feet, and ankles.
Common CVI symptoms that impact the feet, ankles, and legs include:
- feelings of heaviness or fullness
- aches, pain, throbbing or burning
- muscle cramps
- unexplained exhaustion
- edema, or swelling, that often begins in the feet and ankles and moves up as it progresses
- skin discoloration
- ulcers, or open wounds
- varicose veins, swollen, discolored, distended, or twisted veins just beneath the skin’s surface
- scarring or hard, thickened skin
- extremely dry, rough, or scaly skin
A doctor can diagnose CVI by examining the leg or surrounding body parts. They may use a handheld tool called a Doppler ultrasound to listen to the blood flow in the leg.
To confirm their findings or improve the accuracy of their examination, a healthcare professional may also order a venous duplex ultrasound exam. Here, an ultrasound creates an image of the vein that helps identify any blockages or valve dysfunction.
One of the best ways to help manage CVI is wearing compression stockings. These compress blood vessels in the legs, increasing pressure in veins and encouraging blood flow.
Compression stockings are typically graduated, meaning they are most tight around the feet and ankles and reduce in pressure as they move up the leg. Some guidelines recommend choosing stockings with a compression of
Compression stockings come in different sizes, often in line with standard size guidelines. It is important to pick compression stockings that fit well and do not apply too much pressure.
This involves measuring the diameter of the calf, ankles, and thighs to determine the optimal size. A doctor, nurse, or pharmacist may help select the best pair of stockings depending on a person’s size, shape, and severity of their condition.
Speak with a doctor, nurse, or pharmacist about when to wear compression stockings and for how long. It is often best to have them on throughout the day and remove them before bed.
Most people need to have their leg measurements taken for replacement compression stockings every 3–6 months.
Lifestyle changes can also typically help manage CVI, such as:
- eating a healthful, balanced diet
- maintaining a moderate weight
- avoiding sitting or standing for prolonged periods
- exercising, such as walking, to improve the function and strength of calf and leg muscles
- elevating the feet above the thighs when sitting, or above the heart while lying down, 3–4 times per day to reduce swelling
Some people, especially those with severe CVI, may also wish to undergo surgery to repair damaged valves or blocked veins. Types of surgeries used to treat CVI include:
- Vein stripping: A procedure to remove the vein with reflux, often performed while someone is under general anesthesia.
- Ultrasound-guided foam sclerotherapy: With this treatment, a doctor introduces a tiny tube into the vein using ultrasound imaging as guidance. They then inject a foaming substance called a sclerosant, which causes swelling in the vein, cutting off blood flow in the vessel. It eventually shrinks, leaving behind vein scar tissue.
- Ablation: This process uses radiofrequency or lasers to destroy any tissues that characterize CVI.
People may also undergo surgery to repair damage from conditions caused by CVI, such as varicose veins.
Although genetic factors play a part, people can try various approaches to help prevent CVI from occurring, such as:
- avoiding sitting or standing for long periods
- exercising regularly
- eating a healthful, balanced diet
- maintaining a moderate weight
- avoid straining or heavy lifting
- avoid sitting with the legs crossed or one over the other
- treating or reducing high blood pressure
- treating constipation
Venous reflux, or CVI, occurs when veins no longer circulate blood properly. It often affects the leg veins, causing blood to pool and leading to swelling and discomfort.
The easiest way to treat venous reflux is by wearing compression stockings. These can help improve circulation by applying pressure to the legs. A person with severe VRD may also need surgery.
Speak with a doctor if any warning signs or symptoms of venous reflux occur, such as pain, muscle cramps, or swelling. Healthcare professionals can typically manage the condition with various techniques. However, without treatment, symptoms can worsen over time.