Chronic Venous Insufficiency
- Daniel Torrent
- May 20, 2024
- 2 min read
Updated: Jun 6, 2024
Chronic venous insufficiency is a common condition resulting from dysfunction in the valves. Veins have valves which create a one way system. Blood should be flowing away from the limbs and towards the heart. This is especially important in the legs where the flow is fighting gravity all day. If blood tries to flow backwards the valves shut and prevent this. When the valves get leaky this allows blood to flow downwards in the leg and this creates pressure.
This increased pressure causes the symptoms associated with vein disease such as swelling, discomfort, and varicose veins. The symptoms can sometimes be vague and include burning, aching, and restlessness. This is often a result of years of prolonged standing or a family history. Other factors like prior pregnancies or a history of deep vein thrombosis (DVT) can play a role. The diagnosis is made based on symptoms and an ultrasound exam that shows venous reflux. The symptoms can include swelling at the foot and ankle as well as up the leg, discomfort, aching and burning of the leg, restlessness, prominent varicose veins, and discoloration. When the disease is more advanced it can cause skin changes including thickening, discoloration, and ulcerations. The swelling and discomfort symptoms are generally less pronounced in the morning, and there in fact may be no symptoms in the morning. As the day goes on, with standing, the symptoms get worse. The ultrasound to confirm that these symptoms are related to venous insufficiency is done in a standing position or on a table that is steeply inclined with the feet down. The leg is checked at multiple locations while being squeezed to promote reflux. If the valves are working normally they should prevent reflux. If the valve is not functioning then the reflux will be apparent across the valve. The initial treatment for this is conservative and involves compression, elevation, and exercise. Compression generally refers to compression stockings. These stockings have pressure that is tighter towards the bottom and less so towards the top. They promote the flow of blood up the vein to relieve the pooling of fluid lower in the leg. Elevation also works to get blood flowing out of the affected extremity. By having the leg elevated above the level of the heart this promotes blood flow with gravity in the correct direction up the vein. Walking is an excellent exercise that is helpful here. The contraction of the calf muscle promotes flow of blood through the vein system. Together with compression stockings, walking is excellent for alleviating symptoms. If these conservative measures do not improve the symptoms, depending on what vein or veins are involved there are procedures which can be helpful. These usually involve removing the affected vein from circulation to eliminate the reflux. There are multiple ways to do this. This used to be done with vein stripping where the vein was physically removed. It is more commonly now done with procedures to seal the vein either using heat (vein ablation) or chemical means so that there is no further flow through the vein. These procedures are very effective at relieving symptoms and improving quality of life.
