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

Causes

Normally, valves in your deeper leg veins keep your blood flowing back toward the heart so it does not collect in one place. But the valves in varicose veins are either damaged or missing. 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
• Genetic factors
• History of deep vein thrombosis in the legs
• Obesity
• Pregnancy
• Sitting or standing for a long time

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

People with chronic venous insufficiency may also have:

• 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

Treatment

Take the following steps to help manage venous insufficiency:

• Use compression stockings to decrease swelling.
• Avoid long periods of sitting or standing. Even moving your legs slightly will help the blood in your veins return to your heart.
• Care for wounds if you have any open sores or infections.

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)

References

Bergan JJ, Schmid-Schonbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. 2006;355(5):488-498.

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

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