Edit concept Question Editor Create issue ticket

Venous Insufficiency

Insufficiencies Venous

Venous insufficiency refers to the condition in which inadequate volumes of blood from the legs are returned to the heart.


Presentation

There is a range of symptoms that includes the following [6]:

Leg Edema
  • Chronic Venous insufficiency can cause varicose veins, leg edema, leg pain, chronic skin changes, and non-healing ulcers. These problems may make it difficult to sit or stand for extended periods. Schedule an Appointment[gasurgery.com]
  • Stockings should be put on when patients awaken, before leg edema worsens with activity, and should exert maximal pressure at the ankles and gradually less pressure proximally.[msdmanuals.com]
  • See your obstetrician of you experience facial edema, leg edema, or any sudden or severe swelling while pregnant. Edema may continue even after you have given birth.[medicinenet.com]
  • Postphlebitic syndrome is the combination of chronic leg edema with deep venous thrombosis, pigmentation and ulceration. Diagnosis is achieved by duplex ultrasonography (both B-mode and directional pulsed Doppler).[lymphedemapeople.com]
Chronic Fatigue Syndrome
  • We suggest that the method could be also used in the chronic fatigue syndrome and other neurological diseases such as Parkinson or Meniere syndrome.[ncbi.nlm.nih.gov]
Regurgitation
  • A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented.[ncbi.nlm.nih.gov]
  • See also respiratory insufficiency. thyroid insufficiency hypothyroidism. valvular insufficiency failure of a cardiac valve to close perfectly, causing the blood to flow back through the orifice (valvular regurgitation); named, according to the valve[medical-dictionary.thefreedictionary.com]
Heart Failure
  • failure distinguishing factor other symptoms of heart failure, including dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea Pressure ulcers distinguishing factor typically on pressure points and associated with failure to reposition frequently[step2.medbullets.com]
  • When left untreated, CVI can cause problems similar to Congestive Heart Failure or Chronic Obstructive Pulmonary Disease, both of which are serious complications and pose significant threat to the patient’s health.[skinandvein.com]
  • Leg edema tends to be unilateral or asymmetric; bilateral symmetric edema is more likely to result from a systemic disorder (eg, heart failure, hypoalbuminemia) or certain drugs (eg, calcium channel blockers).[msdmanuals.com]
  • Fluid accumulation in the lower extremities (eg, in right heart failure) can also contribute by causing venous hypertension. Prolonged venous hypertension causes tissue edema, inflammation, and hypoxia, leading to symptoms.[merckmanuals.com]
Torticollis
  • The second patient, who was explored on one side only, suffered a protracted postoperative course characterized by suboccipital pain, torticollis, feeding difficulties and persisting hydrocephalus.[ncbi.nlm.nih.gov]
Eczema
  • RESULTS: The healing of ulcers and resolution of venous eczema in 6 months were considered the primary end-point. Healing of ulcers was found in 45/55 (82%) cases in group 1 and in 31/35 (88%) cases in group 2.[ncbi.nlm.nih.gov]
  • Topical treatments are aimed at treating the skin effects of stasis dermatitis, which may manifest as varicose eczema.[pulsetoday.co.uk]
Localized Scleroderma
  • Localized scleroderma is a cutaneous disease that is characterized by an initial inflammatory response, followed by sclerosis of the skin. The cause of localized scleroderma has not yet been determined.[ncbi.nlm.nih.gov]
Cutaneous Manifestation
  • Acrodermatitis chronica atrophicans, the characteristic cutaneous manifestation of late Lyme borreliosis, typically occurs in elderly women. To our knowledge, only 4 cases of acrodermatitis chronica atrophicans in children have been described.[ncbi.nlm.nih.gov]
Pelvic Pain
  • Assessments and interventions consisted of an evaluation for other causes of chronic pelvic pain by a gynecologist; preintervention and postintervention visual analog scale (VAS) pain score; complete venous duplex ultrasound examination; and Clinical,[ncbi.nlm.nih.gov]
Monoplegia
  • Symptoms of fluctuating monoplegia and sensory disturbance appeared monthly, lasting several weeks each time.[ncbi.nlm.nih.gov]
Sleep Disturbance
  • disturbances, absenteeism in the workplace, disability and deteriorated quality of life (QoL).[ncbi.nlm.nih.gov]

Workup

Clinical history and physical examination (including examination of leg veins when the patient is sitting and dangling his legs) are usually adequate to allow a tentative diagnosis.

A duplex ultrasound will allow analysis of blood flow through the veins and rule out the differential diagnoses such as a blood clot.

Human Herpesvirus 8
  • Kaposi sarcoma (KS) is a vascular neoplasm associated with human herpesvirus 8 (HHV-8) infection that can be confused with the clinical and histological findings of chronic venous insufficiency.[ncbi.nlm.nih.gov]

Treatment

Mild conditions are best handled with self-care steps. These include, but are not limited to the following [7]:

  • Regular exercise
  • Compression stockings to decrease swelling
  • Reduction of weight
  • Refraining from sitting or standing for long periods
  • Frequent periods of rest with legs raised above the heart (this may include tilting the patient’s bed)
  • Manual compression by lymphatic massage therapy
  • Prompt attention to sores and wounds

Severe conditions may require more intensive treatments including:

  • Sclerotherapy: Saline or a chemical solution is injected into the damaged vein which causes it to harden and then disappear [8].
  • Venous ablation: Heat closes off and destroys the damaged vein and it disappears with time.
  • Microphlebectomy: The damaged vein is removed through small incisions made in the skin near the vessel.
  • Venous bypass: Blood flow is diverted around the damaged vein using a synthetic tube or a healthy blood vessel taken from elsewhere in the body to make the by-pass or detour.
  • Angioplasty and stenting: A small medical balloon is used to widen the blocked vein in angioplasty when the inflated balloon inside the damaged vessel improves blood flow. The vessel is prevented from collapsing again by inserting a tiny metal mesh tube (stent) inside the vein [9].
  • Endovenous laser ablation: This may be indicated for early signs of venous insufficiency such as tired or heavy legs with pain, persistent skin sores due to poor blood flow or lipodermatosclerosis.

Prognosis

Although chronic venous insufficiency tends to deteriorate over time, it can be successfully managed from the early stages with self-help steps such as adequate exercise, weight control and the use of pressure stockings [5].

Etiology

The most common cause of venous insufficiency is superficial venous reflux and varicose veins. It is commonly found in aging patients who spend most of their day inactive [2].

Epidemiology

There are several risk factors for chronic venous insufficiency. These include [3]:

Recent studies tend to refute the suggestion that women are more prone to develop this condition compared to men.

Sex distribution
Age distribution

Pathophysiology

Leg veins have valves in them to ensure one-way flow of blood back towards the heart. However, if these valves are damaged or the venous walls are weakened, blood may pool in the veins. Chronic venous insufficiency leads to development of varicose veins (both superficial and deep) and superficial venous reflux. The lack of healthy blood flow leads to edema fluid because of the change in local blood pressure altering the dynamics of flow between vascular and tissue fluids. This poor circulation leads to both inadequate tissue perfusion and removal of wastes with subsequent reduced tissue health. Injuries heal less rapidly and infections (e.g. cellulitis) can become more serious and lead to greater spread [4].

Prevention

Healthy lifestyle including adequate exercise and avoiding excessive inactivity is needed to prevent venous insufficiency. Maintaining a healthy weight is also important. Should early signs develop, it becomes important to modify behaviour patterns so that chronic problems do not develop [10].

Summary

Deep veins in the legs have valves in them to ensure a unidirectional flow of blood towards the heart. However, these valves may can become damaged in certain conditions leading to the pooling of the blood in the veins [1]. Early treatment is recommended to prevent chronic insufficiency from developing. It is also known as chronic venous stasis and chronic venous disease.

Patient Information

Venous insufficiency refers to problems associated with inadequate blood returning from the lower legs to the heart. It occurs when the valves in the veins can no longer ensure the one-way flow of blood back to the heart. It is commonly found in ageing patients who spend most of their day inactive. There is a range of symptoms including dull aches, heaviness and cramping in the legs along with itching and tingling. There are changes in skin color along with the development of ulcers in extreme cases. Mild cases can be treated with self-help methods such as compression stockings and lifestyle changes. Exercise and healthy weight are important but resting with the feet above the heart or massage therapy will be beneficial. More severe lesions may need surgery and a variety of techniques are available for different types of chronic venous insufficiency. Maintaining an ideal weight and performing regular exercise are very important in preventing venous insufficiency or restricting it in an early phase.

References

Article

  1. Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. Oct 1973;48(4):839-46.
  2. Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. Oct 2005;30(4):422-9.
  3. Tsai S, Dubovoy A, Wainess R. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg. 2005;19:705-11.
  4. Zaniewski M, Simka M. Biophysics of venous return from the brain from the perspective of the pathophysiology of chronic cerebrospinal venous insufficiency. Rev Recent Clin Trials. May 2012;7(2):88-92.
  5. Evans GA, Evans DM, Seal RM, Craven JL. Spontaneous fatal haemorrhage caused by varicose veins.Lancet. Dec 15 1973;2(7842):1359-61
  6. Bonnetblanc JM. Leg ulcerations: a clinical appraisal. Eur J Dermatol. May-Jun 2005;15(3):127-32.
  7. Zhan HT, Bush RL. A review of the current management and treatment options for superficial venous insufficiency. World J Surg. Oct 2014;38(10):2580-8.
  8. Tretbar LL. Treatment of small bleeding varicose veins with injection sclerotherapy. Bleeding blue blebs.Dermatol Surg. Jan 1996;22(1):78-80.
  9. Raju S, Neglén P. Stents for chronic venous insufficiency: why, where, how and when--a review. J Miss State Med Assoc. Jul 2008;49(7):199-205
  10. Zimmet SE. Venous leg ulcers: modern evaluation and management. Dermatol Surg. Mar 1999;25(3):236-41

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 21:12