• Chronic Venous Insufficiency

    Definition

    Chronic venous insufficiency is caused by higher-than-normal blood pressure within the leg veins.
    Venous Insufficiency
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    Causes

    Chronic venous insufficiency can be caused by blood clots or swelling and inflammation of the veins calledphlebitis. Blood clots in the legs, called deep vein thrombosis , 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.
    Other causes of chronic venous insufficiency include:
    • Absence or weakness of valves in the leg veins that is inherited at birth
    • Increased venous pressure in the legs for any reason
    • Varicose veins

    Risk Factors

    Risk factors that increase your chance of getting chronic venous insufficiency include:
    • Obesity
    • Physical inactivity
    • Increased age (50 and over)
    • Sex: female
    • Family members with deep vein thrombosis or varicose veins
    • Smoking
    • Pregnancy
    • Chronic constipation
    • Regularly sitting or standing for long periods of time
    • Wearing restrictive clothing such as very tight girdles or belts

    Symptoms

    When blood pools in the legs, it puts pressure on the veins. Sometimes, the blood leaks out into the tissues. This can discolor and damage the skin. It may even cause skin ulcers. Symptoms of chronic venous insufficiency can include:
    • 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

    After the valves have been damaged, they usually cannot be repaired. 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/heat 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 prevent chronic venous insufficiency, take steps to decrease your risk factors. These include:
    • Maintain a healthful weight.
    • Exercise regularly.
    • If you smoke, 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 http://www.nhlbi.nih.gov

    Vascular Disease Foundation http://www.vdf.org

    CANADIAN RESOURCES

    Canadian Society for Vascular Surgery http://canadianvascular.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 18th ed. Hoboken, NJ: John Wiley & Sons; 2006.

    Chronic venous insufficiency. Vascular Web website. Available at: http://www.vascularweb.org/vascularhealth/Pages/chronic-venous-insufficiency.aspx . Updated January 2011. Accessed January 29, 2013.

    Fauci AS, Braunwald E, Kasper DL, et al. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: The McGraw-Hill Companies; 2004.

    Venous insufficiency. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 14, 2012. Accessed January 29, 2013.

    2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : 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 http://www.ebscohost.com/dynamed/what.php : Carpentier PH, Satger B. Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency. J Vasc Surg. 2009;49:163-70. Epub 2008 Oct 1.

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