Definition

Venous insufficiency is described as abnormal blood
flow through veins that can cause local damage, damage
to affected legs, or death.

Description

Syndromes related to venous insufficiency are caused
by valve incompetence. Venous insufficiency is a chronic
(long term) condition. The number of new and existing
cases is dependent on age and gender. Some patients may
have a positive family history. Usually older persons and
females are more commonly affected. Deep situated and
superficial veins can be affected. Cancer obstructing veins
in the pelvis area can cause superficial venous insufficiency.
Deep venous insufficiency is commonly caused by
thrombophlebitis, causing obstruction of valves that regulate
blood flow in veins. Small veins that have been
occluded by a thrombosis may re-canalize (opening up
new channels to re-direct blood flow). These re-canalized
veins are inadequate and cannot correct the impairment of
flow. However, larger veins may still remain occluded.
When a thrombosis occurs the valves that regulate venous
blood flow become thickened and incompetent, rendering
them incapable of regulating back flow of blood. This
valvular incompetence will cause an increase in the presence
within veins (venous hypertension). Venous hypertension
is responsible for most of the symptoms associated
with venous disease. Superficial veins can become dilated
causing varicose veins (veins that bulge and seem tortuous).
Leg ulcers can be severe and are responsible for
100,000 cases of disability in the United States alone.

Causes and symptoms

The symptoms of chronic venous insufficiency can
be subjective and objective. Subjective symptoms
include throbbing, cramping, burning sensations, and leg
fatigue. Patients can also develop chronic leg ulcers that
may not heal. Varicose veins in the legs can bleed (since
veins are delicate structures with thin walls) and cause
death. Patients often develop fluid retention (edema) in
the affected limb. Skin changes can occur and affected
areas can become thin, shiny, discolored (blue-purple),
and atrophic. The skin usually becomes thick and tough.

Diagnosis

There are several techniques used to diagnose
venous disease. Electrical impedance plethysmography
(IPG) provides a functional evaluation for outflow
obstruction ultrasound (a machine that transmits sound
waves) studies can visualize the venous system in certain
areas. Another technique called duplex scanning can
measure velocity within a vein.

Treatment

Periodic elevation of legs and bed rest can help with
leg swelling. Patients are advised to avoid prolonged
periods of standing or sitting. Wearing compression
stockings can also reduce swelling of the leg. Mild skin
infections can be treated with compresses, steroids, and,
if infection is present, with antibiotics. Ulceration’s can
be treated with compresses, possible surgery, special
ointments, and a semi-rigid boot that helps improve
blood flow. Varicose veins can be treated with elastic
stockings. About 15–20% of patients require surgery, but
only after careful evaluation and specialized testing confirms
a beneficial value.

Prognosis

The prognosis is variable and depends on the progression
of disease, extent of damage, and the presence
of other diseases, which may affect the cardiovascular
system.

Prevention

Persons who have a strong family history, evidence
of disease, and/or those who stand on their legs many
hours daily should discuss the option of elastic stocking
with their primary clinician.