What is Venous Insufficiency?
Venous insufficiency is a condition which affects the veins of the legs. In healthy veins, blood is pumped from the legs up to the heart. Blood is pumped upwards due to a series of valves within the veins directing blood flow from the superficial veins to the deep veins leading back to the heart. Contraction of the calf muscles also aid in pumping the blood flow back up to the heart.
When the valves within the veins are damaged or not working properly, blood flows backwards resulting in a pooling of blood in the legs. Pooling of blood in the legs increases the pressure in the veins leading to venous hypertension. This increase in pressure can cause mild symptoms of leg heaviness and aching or in chronic cases may progress to severe symptoms.
What are the symptoms?
- Dull aching, heaviness, or cramping in the legs
- Pain relieved with leg elevation and aggravated while standing
- Edema (swelling of the legs)
- Skin discoloration
- Prominent veins (varicose veins)
- Skin ulcers
- Itching, tingling, burning, or throbbing sensation in the legs or feet
- Leg weakness
What are the causes?
- Congenital- born with weak vein walls or abnormal valves
- Deep vein thrombosis (DVT) – blocks the blood flow through a vein. This increases pressure in the vein and may lead to permanent vein or valvular damage.
- Superficial Phlebitis- infection of the superficial vein in the legs can cause damage to the veins and valves.
- Direct leg injury to the veins or valves
- Increase in body weight (i.e. pregnancy, obesity) – increases pressure in the veins
- Weakness in the leg muscles- standing or sitting for long periods of time without walking can decrease the draining of blood from the legs, resulting in increase pressure and pooling of blood.
- Structural compression from other structures in the pelvis.
- Chronic fibrotic changes within the veins
What are the risk factors?
- Family history of venous insufficiency
- Sex: women are more prone than men
- Increasing age
- Varicose veins
- History of deep vein thrombosis
- Prolonged sitting or standing
- Muscle weakness
- Trauma to the legs
What are the complications?
- Swelling of the legs
- Non-healing venous skin ulcers
- Recurrent cellulitis
- Stasis dermatitis
How is it diagnosed?
- Swelling, throbbing, cramping, heaviness, and burning in the legs
- Development of leg pain after standing or sitting for long periods of time
- Pain that is relieved by elevating the legs
- Warmth aggravates symptoms while cold relieves them
- Venous Reflux Study: this is a non-invasive test carried out in our clinic used to detect the presence of venous insufficiency
- Venous Doppler: is a non-invasive test done in our clinic showing the direction of blood flow and detects thrombus (clot) formation
- Magnetic Resonance Venography (MRV): is an imaging study used to provide a detailed picture of the deep and superficial veins of the legs using radio waves within a strong magnetic field
- Direct Contrast Venography: is an invasive test used to detect venous and nonvascular causes of leg pain and edema
- Intravenous Ultrasound (IVUS): A catheter is placed into the veins in the pelvis and an ultrasound image is taken from inside the vein. This gives an accurate assessment of whether there are any obstructions to blood flow.
How is it treated?
- Weight loss: Losing weight can boost the blood flow in your legs.
- Leg Elevation: Legs are elevated just above the level of your heart for about 30 minutes and should be done three to four times a day. Elevation improves the drainage of blood and metabolites from the lower extremities. This helps relieve symptoms in patients with mild venous insufficiencies.
- Exercise: Foot and leg exercises help to improve symptoms. Movement helps prevent stasis of blood and also helps the calf muscles pump blood up towards the heart.
- Graduated Compression: this is the cornerstone of treatment.
- Sclerotherapy: is a chemical ablation done by injecting a sclerosing agent into the vein, causing the vein to collapse.
- Thermal Ablation: is a minimally invasive technique using intense thermal energy to irreversibly destroy an incompetent or diseased vein. This procedure is carried out in our clinic.
- Vein ligation or Stripping: is a surgical procedure done to remove veins requiring the use of incisions. Ligation and stripping are becoming outdated due to ablation techniques.
- Venous Stenting: is a procedure similar to stents in other blood vessels, where a wire is guided through a narrowed portion of a blood vessel, after which a balloon is used to open the vein up to its original size. finally, a metal stent is placed, to act as scaffolding, keeping the vessels open.
Video Showing how a stent is placed.
How can I prevent this?
- Lose weight
- Avoid prolonged standing or sitting
- Be more physically active by walking or running to promote the calf pumping function
- Elevate your legs to improve circulation
- Correct the underlying problem to prevent progression
- Change your sitting or standing position regularly
- Protect your legs from injury