Chronic
Venous Insufficiency
Chronic
venous insufficiency occurs when the leg veins
do not allow blood to travel back to the heart.
(Arteries carry blood away from the heart, while
veins carry blood to the heart). Problems with
valves in the veins can cause the blood to flow
both directions, not just toward the heart. These
valves that are not working properly can cause
blood in the legs to pool. If chronic venous insufficiency
is left untreated, pain, swelling, and leg ulcers
may result.
Chronic
venous insufficiency does not pose a serious health
threat, but the condition can be disabling and
cause pain. The condition affects about 5 percent
of the US population. It usually occurs in men
between the ages of 70 to 79 and in women between
the ages of 40 to 49. Estimates are that about
500,000 persons in the US have ulcers of the lower
legs that are a result of this condition.
Chronic
venous insufficiency is more common among those
who are obese, pregnant, or who have a family
history of the problem. Individuals who have had
trauma to the leg through injury, surgery, or
previous blood clots are also more likely to develop
the condition.
Other
causes of chronic venous insufficiency include,
but are not limited to, the following:
- high blood pressure
in the leg veins over a long time, due to sitting
or standing for prolonged periods
- lack of exercise
- smoking
- deep vein thrombosis
(a blood clot in a deep vein, usually in the
calf or thigh)
- phlebitis (swelling
and inflammation of a superficial vein, usually
in the legs)
Symptoms
of chronic venous insufficiency may include:
- swelling in legs and/or
ankles
- tight feeling calves
or itchy painful legs
- pain during walking
that stops with rest
- brown-colored skin,
particularly near the ankles
- varicose veins
- leg ulcers
The
symptoms of chronic venous insufficiency may resemble
other conditions. Consult your physician for a
diagnosis.
In addition
to a complete medical history and physical examination,
diagnostic procedures for chronic venous insufficiency
may include:
- duplex ultrasound
- a type of vascular ultrasound procedure done
to assess blood flow and the structure
of the leg veins. The term "duplex"
refers to the fact that two modes of ultrasound
are used - Doppler and B-mode. The B-mode transducer
(like a microphone) obtains an image of the
vessel being studied. The Doppler probe within
the transducer evaluates the velocity and direction
of blood flow in the vessel.
- venogram - uses x-rays
and intravenous (IV) contrast dye to visualize
the veins. Contrast dye causes the blood vessels
to appear opaque on the x-ray image, allowing
the physician to visualize the blood vessels
being evaluated.
Specific
treatment will be determined by your physician
based on:
- your age, overall health
and medical history
- extent of the disease
- your tolerance for
specific medications, procedures, or therapies
- your signs and symptoms
- expectations for the
course of the disease
- your opinion or preference
Chronic
venous insufficiency treatment may include:
- measures to improve
blood flow in the leg veins
Methods to help increase blood flow in the leg
veins include elevating the legs to reduce pressure
in the leg veins and compression stockings to
apply pressure on the legs and help blood flow.
Other methods include keeping the legs uncrossed
when sitting and regular exercise.
- medications
Several types of medications may be used to
treat chronic venous insufficiency. Diuretics
(medications used to draw excess fluid from
the body through the kidneys) may be used to
reduce swelling. Aspirin may be prescribed for
healing leg ulcers. Pentoxifylline, which improves
the flow of blood through the vessels, may be
used in combination with compression therapy
to help heal leg ulcers.
Anticoagulation therapy (blood thinning medication)
may be recommended for those persons who have
recurring problems with the veins in their legs.
- sclerotherapy
For patients whose condition is more advanced,
sclerotherapy may be prescribed. This involves
injecting a chemical into the affected veins.
The chemical causes scarring in the veins so
that they can no longer carry blood. Blood then
returns to the heart through other veins and
the body absorbs the scarred veins.
- surgery
Surgery is recommended in fewer than 10 percent
of people with chronic venous insufficiency.
Surgical procedures that may be used to treat
the condition include:
- ligation - tying
off an affected vein so that blood no longer
flows through it. If the vein and/or its
valves are heavily damaged, the vein will
be removed ("vein stripping").
- surgical repair
- a vein and/or valves may be surgically
repaired, either through an open incision
or with the use of a long catheter (hollow
tube).
- vein transplant
- transplanting a healthy vein from another
body area and replacing the diseased vein
with the healthy vein.
- subfascial endoscopic
perforator surgery - a minimally-invasive
procedure performed with an endoscope (a
small, flexible tube with a light and a
lens on the end). The perforator veins (veins
found in the calf area) are clipped and
tied off. This allows blood to drain into
healthy veins and improves ulcer healing.
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