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Venous Insufficiency

Definition

Venous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart.

Alternative Names

Chronic venous insufficiency; Chronic venous stasis; Chronic venous disease

Causes

Normally, valves in your deeper leg veins keep blood moving forward toward the heart. With chronic venous insufficiency, vein walls are weakened and valves are damaged. This causes the veins to stay filled with blood, especially when you are standing.

Chronic venous insufficiency is a long-term condition. It occurs because a vein is partly blocked, or blood is leaking around the valves of the veins.

Risk factors for venous insufficiency include:

  • Age
  • Being female (related to levels of the hormone progesterone)
  • Being tall
  • Family history of this condition
  • History of deep vein thrombosis in the legs
  • Obesity
  • Pregnancy
  • Sitting or standing for a long periods

Symptoms

  • Dull aching, heaviness, or cramping in legs
  • Itching and tingling
  • Pain that gets worse when standing
  • Pain that gets better when legs are raised
  • Swelling of the legs
  • Redness of the legs and ankles
  • Skin color changes around the ankles
  • Varicose veins on the surface (superficial)
  • Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
  • Ulcers on the legs and ankles
  • Wound that is slow to heal on the legs or ankles

Exams and Tests

Your doctor will do a physical exam and ask about your symptoms and medical history. Diagnosis is often made based on the appearance of leg veins when you are standing or sitting with your legs dangling.

A duplex ultrasound exam of your leg may be ordered to:

  • Check blood flow in the veins
  • Rule out other problems with the legs, such as a blood clot

Treatment

Your doctor may suggest that you take the following self-care steps to help manage venous insufficiency.

  • Wear compression stockings to decrease swelling.
  • Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
  • Care for wounds if you have any open sores or infections.
  • Lose weight if you are overweight.

If your condition is severe, your doctor may recommend the following treatments:

  • Sclerotherapy: Salt water (saline) or a chemical solution is injected into the vein. The vein hardens and then disappears.
  • Ablation: Heat is used to close off and destroy the vein. The vein disappears over time.
  • Vein stripping: Small surgical cuts (incisions) are made in the leg near the damaged vein. The vein is removed through one of the incisions.
  • Bypass: This is surgery to reroute blood flow around the blocked vein. A tube or blood vessel taken from your body is used to make a detour around, or bypass, the damaged vein.
  • Valve repair: A small incision is made in the leg and the damaged valve is repaired.
  • Angioplasty and stenting: This is a procedure to open a narrowed or blocked vein. Angioplasty uses a tiny medical balloon to widen the blocked vein. The balloon presses against the inside wall of the vein to open it and improve blood flow. A tiny metal mesh tube called a stent is then placed inside the vein to it from narrowing again.

Surgery (varicose vein stripping) or other treatments for varicose veins may be recommended if you have:

  • Leg pain, which may make your legs feel heavy or tired
  • Skin sores caused by poor blood flow in the veins
  • Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)

Outlook (Prognosis)

Chronic venous insufficiency tends to get worse over time. By taking self-care steps, you may be able to ease discomfort and slow the condition from getting worse. It is likely that you will need medical procedures to treat the condition.

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

  • You have varicose veins and they are painful
  • Your condition gets worse or does not improve with self-care, such as wearing compression stockings or avoiding standing for too long
  • You have a sudden increase in leg pain or swelling, fever, redness of the leg, or leg sores

References

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa.: Elsevier Saunders; 2012: chap 65.

Word R. Medical and surgical therapy for advanced chronic venous insufficiency. Surg Clin N Am. 2010;90:1195–1214.


Review Date: 5/21/2013
Reviewed By: Diane M. Horowitz, MD, North Shore Long Island Jewish Health System, Great Neck, NY. Review provided by VeriMed Healthcare Network.
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