VEIN TREATMENT

Venous Insufficiency

What Is Venous Insufficiency?

Venous insufficiency is a condition that occurs when the veins in the legs are not working properly and have difficulty sending blood back to the heart. Chronic venous insufficiency (CVI) is another name for this condition, due to its long-term nature. CVI causes venous stasis, where the blood collects or pools in these veins.

Other names for this condition include:

  • Venous reflux disease
  • Chronic venous stasis
  • Chronic venous disease
  • Leg ulcer
  • Varicose veins

Symptoms

CVI can lead to potentially severe consequences, most notably pulmonary embolism, where a blood clot blocks the flow of blood to the lungs, starving lung tissue of oxygen. Treatment becomes more complex as CVI progresses. Due to these factors, watching for the following symptoms and getting early treatment are important. Venous insufficiency symptoms in the legs include:

  • Pain
  • Dull aching
  • Feeling of heaviness
  • Cramping
  • Itching and tingling
  • Surface varicose veins and spider veins
  • Pain that worsens when standing
  • Pain that abates when legs are raised
  • Swelling
  • Irritated or cracked skin
  • Wound or ulcer that is slow to heal on the legs or ankles
  • Stasis dermatitis – red, swollen, crusted, or weepy skin
  • Lipodermatosclerosis – thickening and hardening of the skin on the legs and ankles

CVI is associated with varicose veins, which are enlarged, swollen and twisted veins close to the surface of the skin, often appearing blue or purple. They can occur almost anywhere, but most commonly occur in the legs. Spider veins are also common, which are smaller red, purple, and blue twisted vessels that are visible under the surface of the skin.

CVI can also cause burst capillaries, causing local tissue inflammation and internal tissue damage. This condition leads to ulcers on the skin surface. These venous stasis ulcers are difficult to heal and are in danger of infection. If the infection is not controlled, it can spread to surrounding tissue, causing a condition called cellulitis.

Though there are many symptoms associated with venous insufficiency, some people do not have any symptoms. These cases are more dangerous because the patient may not be alerted to this serious problem.

Venous Insufficiency

Causes and Risk Factors

When functioning properly, deeper leg veins keep blood moving toward the heart. In chronic venous insufficiency, the vein walls become weak and valves are damaged, causing the blood to leak backwards and stay in the veins, especially while standing. CVI is most often due to malfunctioning valves in the veins or most commonly as a result of a past blood clot in the legs.

A blood clot in the deep veins of the legs is a serious condition known as deep vein thrombosis (DVT). CVI also may occur from pelvic tumors and vascular malformations. In some cases, no cause is determined. CVI that occurs due to DVT is also known as post-thrombotic syndrome. Up to 30 percent of patients with DVT will develop CVI within 10 years after diagnosis.

Risk factors for venous insufficiency include:

  • Age
  • Tall height
  • Smoking
  • Sitting or standing for long periods
  • History of deep vein thrombosis in the legs
  • Family history of this condition
  • Female gender (related to levels of the hormone progesterone)
  • Obesity
  • Pregnancy

Diagnosis

A complete medical history and physical exam are performed. During the physical exam, the legs are carefully examined and a test called a vascular or duplex ultrasound may be used to examine the blood circulation of the legs. This test creates an image of the blood vessel and displays it on a monitor.

A venogram may also be performed. During a venogram, an intravenous (IV) contrast dye is injected into the veins. The contrast causes the vessels to appear opaque on an X-ray, allowing a better view of the veins.

Treatment

Venous insufficiency treatment is most treatable in its earliest stages. Vascular medicine or vascular surgery specialists usually recommend a combination of treatments. The goals are to reduce pooling of blood and prevent leg ulcers.

CVI worsens over time. Taking self-care steps is the best way to ease pain and irritation and prevent the condition from getting worse. Early self-care treatment strategies include:

  • Wear compression stockings. This first-line therapy gently squeezes the legs, moving blood up the legs and improving blood flow. Compression stockings prevent leg swelling and are a measure to help prevent blood clots.
  • Avoid long periods of standing or sitting
  • Exercise regularly, especially walking
  • Lose weight if overweight
  • Elevate legs above the level of the heart while sitting and lying down
  • Diligently practice good skin hygiene
  • Treat skin infections with antibiotics
  • If taking a long trip, flex and extend legs, feet, and ankles 10 times every 30 minutes to keep blood flow going in the leg veins
  • If standing for long periods is required, take frequent breaks to sit down and elevate the feet
  • In cases of post-thrombotic syndrome, medication may be prescribed to prevent the formation of additional blood clots:
    • Unna Boot – a special medicated wrap that combines multilayer compression with a zinc oxide gel-based wound cover to forms semi-rigid bandage.

When CVI becomes more progressed, more invasive treatments may be recommended. The following symptoms may require invasive treatment:

  • Leg pain that makes legs feel heavy or tired
  • Skin sores that do not heal or recur
  • Thickening and hardening of the skin on the legs and ankles

Invasive medical treatment procedures include:

  • Phlebectomy – small incisions are made in the leg near the damaged vein and the vein is removed
  • Sclerotherapy – saline or a chemical solution is injected into a vein, which hardens and then disappears
  • Varicose vein stripping – a large vein in the leg called the superficial saphenous vein is removed or tied off
  • Vein bypass – a portion of a healthy vein is used to replace a damaged portion of another
  • Lasers or radiofrequency treatments, such as endovenous thermal ablation
  • Catheter procedure – used to heat and seal off a larger vein

If you have symptoms of venous insufficiency, contact us today to ask questions or schedule an appointment with one of our clinical staff.