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Venous insufficiency

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

Venous insufficiency

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.

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Chronic venous insufficiency is a long-term condition. It is most commonly due to malfunctioning (incompetent) valves in the veins. It may also occur as the result of a past blood clot in the legs.

Risk factors for venous insufficiency include:

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

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.
  • Exercise regularly.

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.
  • Microphlebectomy. Small surgical cuts (incisions) are made in the leg near the damaged vein. The vein is removed through one of the incisions.
  • Bypass. Surgery reroutes 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.
  • Angioplasty and stenting. A procedure opens 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 prevent it from narrowing again.

Endovenous laser ablation or radiofrequency ablation 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)

Surgery (varicose vein stripping ) to treat chronic venous insufficiency has been largely replaced by less invasive procedures .

Outlook (Prognosis)

Chronic venous insufficiency tends to get worse over time. However, it can be managed if treatment is started in the early stages. By taking self-care steps, you may be able to ease the discomfort and prevent 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 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.

Updated: 5/27/2014

Deepak Sudheendra, MD, Assistant Professor of Interventional Radiology & Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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