Venous insufficiency is a condition that occurs when the venous wall or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. When this happens, the blood “leaks” back down the blood vessels causing it to “pool” or collect in the veins, especially in the ankles and feet. An early symptom of this condition is swelling (edema) of the ankles and feet.
Chronic venous insufficiency (CVI) leads to skin changes, skin ulcers, and infections. The condition does not generally pose a serious health threat, but it can be disabling and cause pain.
Venous insufficiency is quite common, and often a chronic condition. Estimates show that CVI affects up to 40% of the U.S population. The condition has been known since ancient times when Hippocrates wrote of using bandaging to treat it.
Arteries carry blood from the heart to the rest of the body. Veins carry blood back to the heart.
Veins in the legs have one-way valves that keep blood flowing toward the heart, and not flowing backwards. If the venous wall and/or valves don’t work correctly, it’s difficult for blood to be pumped up to the heart.
This condition is called venous insufficiency. Instead of blood flowing back to the heart, the blood often pools (stasis) in the veins of the legs. When chronic venous insufficiency is left untreated, it results in pain, swelling, and leg ulcers may develop.
An estimated 40 percent of people in the United States have CVI. Venous insufficiency is more common in women than in men. It is also more likely to occur in women between the ages of 40 and 49, and in men between 70 and 79.
What Causes Venous Insufficiency?
Several factors can cause venous insufficiency, though it’s most commonly caused by blood clots (deep vein thrombosis) and varicose veins. When blood flow is obstructed — such as in the case of a blood clot — blood builds up below the clot, which can lead to venous insufficiency.
In varicose veins, the valves are often missing or impaired and blood leaks back through the damaged valves. In some cases, weakness in the leg muscles that squeeze blood forward can also contribute to venous insufficiency; therefore, a lack of exercise is another cause of venous insufficiency. Additionally, sitting or standing for long stretches of time can raise the pressure in the veins and may weaken the valves.
In some cases, for unknown reasons, vein valves can become ineffective after an extended period of standing. Individuals who have had leg trauma from an injury, surgery, or previous blood clots are also more likely to develop the condition. Other causes of chronic venous insufficiency include, but are not limited to:
A history of blood clots.
Over the age of 50.
Deep vein thrombosis (a blood clot in a deep vein, usually in the calf or thigh).
Family history of venous insufficiency.
High blood pressure in the leg veins over a long time, due to sitting or standing for prolonged periods.
Chronic venous insufficiency that develops because of a DVT is also known as post-thrombotic syndrome. As many as 30 percent of people with a DVT will develop this problem within 10 years after diagnosis.
What are the Symptoms of Venous Insufficiency?
Many symptoms of chronic venous insufficiency resemble other conditions. Most are mild, and not limb-threatening. However, it is important to see a vein specialist for proper diagnosis and treatment.
Without treatment, the pressure and swelling in the blood vessels may burst the tiny blood vessels (capillaries) in the legs. Should the capillaries burst, the skin may turn reddish-brown, especially near the ankles. This can lead to swelling and ulcers. The ulcers are difficult to heal and can become infected, causing additional problems. Ulcers are less likely to develop, if treatment begins early.
Other symptoms of chronic venous insufficiency can include:
Aching, throbbing legs or a feeling of heaviness in the legs.
Pain that gets worse when standing and subsides when the legs are elevated.
Pain when walking that subsides when resting.
Thickening skin that may have the appearance of leather.
To properly diagnose venous insufficiency, a doctor will review the patient’s medical history and check the blood flow in the legs. The two primary diagnostic procedures for checking blood flow are a duplex ultrasound and a venogram.
Duplex ultrasound. A vascular ultrasound. The term “duplex” refers to the fact that two modes of ultrasound are used. The duplex ultrasound combines traditional and Doppler ultrasound. Traditional ultrasound uses a transducer that both sends sound waves into the body and receives the echoing waves which a computer uses to create an image. Doppler ultrasound records sound waves reflecting off moving objects, such as blood, to measure their speed and other aspects of how they flow.
Venogram. Uses X-rays and intravenous (IV) contrast dye to visualize the veins. Contrast dye causes the blood vessels to appear opaque on the X-ray image, allowing the doctor to visualize the blood vessels being evaluated. A venogram is one of the more accurate tests doctors use to diagnose deep vein thrombosis (DVT), as well as other abnormalities.
In cases of severe swelling, or if the condition proves difficult to treat, the doctor may want to run a computer tomography (CT) scan of the venous system. This test helps the doctor find vein narrowing or blockages.
How is Venous Insufficiency Treated?
The goal of treating chronic venous insufficiency is to improve blood flow in the leg veins, stop the swelling, and prevent leg ulcers. Specific treatment will depend on:
The patient’s age, overall health, and medical history.
Extent of the CVI and the signs and symptoms of the disease.
The patient’s tolerance for specific medications, procedures, or therapies
Most treatment is nonsurgical. In most cases, conservative measures are used to improve blood flow in the leg veins. If the conservative measures fail to achieve the desired results, the doctor will turn to medication and non-invasive and minimally-invasive procedures. Surgery is necessary in fewer than 10 percent of the cases of chronic venous insufficiency.
Conservative measures that may help increase blood flow in the leg veins include:
Compression stockings are worn to apply pressure on the legs and help blood flow. The stockings also aid in healing ulcers.
Elevating the legs to reduce pressure in the leg veins.
Exercise to help the body pump blood. Walking is a good, simple way to increase leg strength as well as boost blood flow.
Keep legs uncrossed when sitting.
Movement is important. Patients are encouraged to not sit or stand for a long time, if possible. If you must sit for an extended period, stretch, or wiggle your legs, feet, and ankles often to help blood flow. If you stand a lot, take breaks to sit and put your feet up. This helps lower pressure in your leg veins.
Medications, such as diuretics (medications used to draw excess fluid from the body through the kidneys) is not typically used to treat CVI unless there are additional, separate conditions (such as heart failure or kidney disease) that are also contributing to the swelling.
The use of medications to improve blood flow may be used in combination with compression therapy to help heal leg ulcers. The types of medication that can treat chronic venous insufficiency include:
Anticoagulation therapy (blood thinning medication) for those with recurring problems with veins in their legs.
Aspirin may be prescribed for healing leg ulcers.
Antibiotics may also be prescribed to treat leg ulcers.
Specific medicine (pentoxifylline) may be prescribed to improve the flow of blood through the vessels. It may be used in combination with compression therapy to help heal leg ulcers
Ambulatory phlebectomy. An outpatient procedure for removing smaller varicose veins.
Laser surgery. A treatment with strong surges of light in a small, specific place that collapses and seals the damaged vein. Over time, the vessel fades. The procedure involves no surgical cuts.
Sclerotherapy. A treatment generally reserved for advanced venous insufficiency. In sclerotherapy, a chemical is injected into the damaged vein so that it’s no longer able to carry blood. Instead, the blood returns to the heart through healthier veins. Over time, the body absorbs the treated vein.
Catheter procedures. The doctor inserts a catheter (thin tube) into the vein. The end is heated, and then it is slowly removed from the vein. The heat causes the vein to close and seal as the catheter is taken out.
Subfascial Endoscopic Perforator Surgery (SEPS). An endoscope (small, flexible tube with a light and a lens on the end) is inserted into the perforator veins (found in the calf area). The veins are clipped and tied off allowing blood to drain into healthy veins. The procedure helps improve healing from ulcers.
Sometimes more serious cases of venous insufficiency require surgery. However, surgery is recommended in fewer than 10 percent of the chronic venous insufficiency cases. Surgical procedures that may be used include:
Angioplasty and in severe cases, these minimally invasive procedures widen narrowed or obstructed veins when deep veins are affected.
Ligation. Tying off an affected vein so that blood no longer flows through it. If the vein or valves are heavily damaged, the vein can be removed (“vein stripping”).
Surgical repair. A vein and/or valves may be surgically repaired, either through an open incision or with the use of a long catheter (hollow tube).
Vein bypass. This is done on veins in the upper thigh and only in the most severe cases when other procedures have failed. A healthy vein from another part of the body is used to reroute blood around the affected vein. The procedure usually requires a hospital stay for 2-5 days.
Vein repair. Surgery to “fix” the vein or valves. This can be done through an open cut on the leg or through a smaller opening by using a long, hollow catheter or tube.
Vein transplant. The transplantation of a healthy vein from another area of the body to replace the diseased vein.
Even with successful treatment, a recurrence of venous insufficiency is common and may require additional treatment.
Is It Possible to Prevent Venous Insufficiency?
There are steps you can take to stay healthy and lessen the chances of developing the condition, especially if there is a family history of venous insufficiency:
Don’t sit or stand in one position for long stretches of time; get up and move around frequently.
Don’t smoke, and if you do smoke, quit.
Get regular exercise.
If you have had a deep vein thrombosis (DVT), it is essential to stick with any prescribed anticoagulation medications.
Maintain a healthy body weight.
Maintain good skin care.
Wear compression garments.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating venous insufficiency. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.