Chronic Venous Insufficiency occurs when the leg veins do not allow blood to travel back to the heart. (Arteries carry blood away from the heart, while veins carry blood to the heart). Problems with valves in the veins can cause the blood to flow both directions, not just toward the heart. These valves that are not working properly can cause blood in the legs to pool. If chronic venous insufficiency is left untreated, pain, swelling, and leg ulcers may result.
Chronic venous insufficiency does not pose a serious health threat, but the condition can be disabling and cause pain. The condition affects about 5 percent of the US population. It usually occurs in men between the ages of 70 to 79 and in women between the ages of 40 to 49. Estimates are that about 500,000 persons in the US have ulcers of the lower legs that are a result of this condition.
Symptoms And Signs
Clinically evident chronic venous insufficiency may not cause any symptoms but always causes signs; postphlebitic syndrome always causes symptoms. Both disorders are a concern because their symptoms can mimic those of acute DVT and both can lead to substantial reductions in physical activity and quality of life.
Symptoms include a sense of fullness, heaviness, aching, cramps, pain, tiredness, and paresthesias in the legs; these symptoms worsen with standing or walking and are relieved by rest and elevation. Pruritus may accompany skin changes. Signs occur along a continuum: no changes to varicose veins (rare) to stasis dermatitis on the lower legs and at the ankles, with or without ulceration The calf may be painful when compressed.
What are the risk factors for Venous Insufficiency ?
Some of the risk factors that can contribute to venous insufficiency are:
- Older age
- Varicose veins
- Previous deep vein thrombosis (blood clot)
- Family history (other members of the family suffer from the disorder)
- Muscle weakness
- Injury to the legs
- Clinical diagnosis
- Ultrasonography to exclude DVT
Diagnosis is usually based on history and physical examination. A clinical scoring system that ranks 5 symptoms (pain, cramps, heaviness, pruritus, paresthesia) and 6 signs (edema, hyperpigmentation, induration, venous ectasia, blanching hyperemia, pain with calf compression) on a scale of 0 (absent or minimal) to 3 (severe) is increasingly recognized as a standard diagnostic tool of disease severity. Scores of 5 to 14 on two visits separated by ≥ 6 mo indicate mild-to-moderate disease, and scores of ≥ 15 indicate severe disease.
Lower-extremity duplex ultrasonography helps exclude DVT. Absence of edema and a reduced ankle-brachial index suggest peripheral arterial disease rather than chronic venous insufficiency and postphlebitic syndrome.
Primary prevention involves adequate anticoagulation after DVT and use of compression stockings for up to 2 yr after DVT or lower extremity venous trauma. Lifestyle changes (eg, weight loss, regular exercise, reduction of dietary NaCl) can decrease risk by decreasing lower extremity venous pressure.
How is Venous Insufficiency Treated ?
There are many treatment options for venous insufficiency, depending upon the condition that is causing it. The most common treatment for venous insufficiency is prescription-wear compression stockings. These special elastic stockings apply pressure at the ankle and lower leg and improve venous blood flow and reduce leg swelling.
Compression stockings are available in a range of prescription strengths and in different lengths (such as knee-high or thigh-high stockings). Your physician will determine the type of compression stocking that is most appropriate for your care. In some cases when a non-healing ulcer (sore) is present, a physician may prescribe special medicated wraps (such as an Unna boot) to reduce swelling and treat the skin ulcer.
To further help with the leg swelling caused by venous insufficiency, your doctor may also tell you to keep your legs elevated above your heart when you are lying down. He or she may also suggest that you get more exercise; for example, walking can improve your circulation. Weight loss can also be very helpful for treatment of venous insufficiency for patients who are overweight.
For patients with venous insufficiency caused by blood clots, doctors commonly prescribe anticoagulants or blood thinners. This treatment works on existing blood clots and also prevents additional clots from forming.
If you have been diagnosed with chronic venous insufficiency, you can help the pooled blood to drain by elevating your feet whenever you are sitting or lying down. Your feet should be raised above the level of your heart. Avoid any long periods of sitting or standing. If you must take a long trip, flex and extend your legs, feet, and ankles about 10 times every 30 minutes to keep the blood flowing in the leg veins. If you wear elastic stockings, be sure to take them off each day to wash and dry them, and to clean and check your skin and give it some air. Make sure the stockings fit so there is no bunching. Elastic stockings that fit poorly will actually make your condition worse by blocking blood flow in the area where they have bunched up. Also keep your skin moisturized so that it doesn’t flake or crack easily. Follow your doctor’s recommendations for daily exercise so it is easier to maintain a healthy weight.
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