Chronic Venous Insufficiency
En Español (Spanish Version)

Definition
Chronic venous insufficiency is a problem with how your veins are working. Veins collect blood from the body to bring back to the heart. The veins have one-way valves throughout the blood vessel that keeps the blood moving in the right direction, toward the heart. When these valves do not close properly, blood can leak backwards. This can cause a back up of blood in the veins especially areas of the body where veins must work against gravity like the legs.

Venous Insufficiency

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Causes
Chronic venous insufficiency is caused by higher than normal pressure in the veins and damage to the valves that keep blood flowing toward the heart. It can be caused by blood clots or swelling and inflammation of the veins called. Blood clots in the legs can damage the valves in the veins. When people get chronic venous insufficiency after a blood clot, it may be referred to as post-thrombotic syndrome. When it occurs after phlebitis, it may be referred to as post-phlebitic syndrome.

Causes of chronic venous insufficiency include:

  • Deep vein thrombosis
  • Phlebitis
  • Absence or weakness of valves in the leg veins that is inherited at birth
  • Increased venous pressure in the legs for any reason
Risk Factors
Chronic venous insufficiency is more common in women and in people aged 50 years and older. Other factors that may increase your chance of getting chronic venous insufficiency include:

  • Obesity
  • Physical inactivity
  • Family members with deep vein thrombosis or varicose veins
  • Smoking
  • Pregnancy
  • Regularly sitting or standing for long periods of time
  • Wearing restrictive clothing such as very tight girdles or belts
Symptoms
Chronic venous insufficiency may cause:

  • Swelling of the legs
  • Pain in the legs, especially after walking:
    • Aching
    • Dullness
    • Tiredness
    • Cramping
  • Red or brown darkening of the skin on the legs
  • Varicose veins
  • Ulcers on legs, especially around the inside of the ankles
  • Scaling skin on legs
  • Hard, leathery skin on legs
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. If the diagnosis is not clear from the exam or you are considering surgery, your doctor may have images taken of your bodily structures. This can be done with:

Treatment
Treatment is aimed at maintaining blood flow and preventing it from pooling. Treatment involves the following:

Improving Blood Flow
Your doctor may have you wear special elastic stockings that squeeze the veins in the legs. They will help keep the blood from pooling. You may also be advised to raise your feet and legs above the level of your heart while resting or sleeping. You may need to do this several times a day.

Movement
Your doctor may encourage you to walk and do specific exercises for your legs and feet. You should also avoid long periods of sitting and standing. If you go on an extended trip, get up and walk, or flex your leg muscles every 30 minutes.

Skin Care
Mineral bath therapy may help to improve skin redness. You also may be advised to use bandages or apply an antibiotic cream to help prevent skin infection. Wearing compression stockings may also promote healing.

Sclerotherapy or Ablation
Your doctor may recommend sclerotherapy. This treatment involves injecting a caustic material into the affected veins. Scar tissue fills the veins. The blood is rerouted through functioning veins. Ablation is another procedure used to treat the veins. A tiny electrode is inserted into the affected vein. Electricity scars the vein and blocks it off.

With both treatments, your body will resorb the non-functional vein over time.

Surgery
Surgery is reserved for the few cases that do not respond to conservative treatment. The type of surgery will depend on the cause of the condition and the results of testing. Some possibilities include:

  • Valve repair
  • Vein stripping to remove the faulty vein.
  • Bypass surgery—A new length of artificial vein is connected to two areas of the malfunctioning vein. This allows the blood flow to bypass the area that is not working.
Prevention
To help reduce your chance of developing chronic venous insufficiency, take these steps:

  • Maintain a healthful weight
  • Exercise regularly
  • If you smoke, talk to your doctor about how to quit
  • Avoid standing or sitting for long periods of time
  • Avoid wearing restrictive clothing such as girdles or belts



RESOURCES:
National Heart, Lung, and Blood Institute

Vascular Disease Foundation

CANADIAN RESOURCES:
Canadian Society for Vascular Surgery


References:
Chronic venous insufficiency. Vascular Web website. Available at: http://www.vascularweb.org/vascularhealth/Pages/chronic-venous-insufficiency.aspx . Updated January 2011. Accessed August 7, 2013.

Venous insufficiency. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated July 10, 2013. Accessed August 7, 2013.

2/17/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : O'Meara S, Cullum N, Nelson E. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2009;(1):CD000265.

2/17/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Carpentier PH, Satger B. Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency. J Vasc Surg. 2009;49:163-170.

Last Reviewed August 2013



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