Chronic venous insufficiency begins as a venous insufficiency. The veins fail and are unable to circulate the blood adequately from the body back to the heart. When treatment is not received in a timely manner, the symptoms manifest and the condition becomes chronic. This results in the valves or the venous walls of the veins impacted not working properly. The legs are the most commonly affected area for this condition. Chronic venous insufficiency causes the blood to have more difficulty returning to the heart from the affected area such as the legs. The blood starts to collect within the veins. This is called stasis. Potential serious complications can result if the condition is not treated. This condition is fairly common and impacts almost forty percent of the population of the United States and the United Kingdom. The condition is more common in adults who have reached middle age or older and women. This is especially true if the woman has had multiple pregnancies.
The Causes of Chronic Venous Insufficiency
The most common cause of this condition is a blot clot located within the leg’s deepest veins. This is referred to as (DVT) deep vein thrombosis. The condition can also result from vascular malformations, pelvic tumors, untreated high blood pressure of the leg veins, not enough exercise, standing or sitting for lengthy periods and smoking.
The Risk Factors for Chronic Venous Insufficiency
During the earliest stages of this condition, the symptoms are often subtle. Numerous individuals are unfamiliar with the warning signs including darker skin near the ankles and itchy legs. The signs are dismissed as ordinary discoloration, tan lines or dry skin. If several or all of the following symptoms or statistics are present, the individual should see a vascular specialist as soon as possible. This includes:
- Darkening or brownish skin on the lower legs
- Leg pain while walking, sitting or at rest
- Leg ulcers
- (DVT) Deep vein thrombosis
- Restlessness, itchiness or consistent leg cramps
- Swelling in the ankle or lower leg
- A tightening in the calves
- A family or personal history of varicose veins
- New varicose veins
- The individual is fifty years of age or older
- A recent injury
- Sitting or standing often for long periods of time
- Not moving or resting the legs for long periods of time
When You Should Seek Treatment for Chronic Venous Insufficiency
Despite the large percentage of the population with chronic venous insufficiency, only ten percent seek treatment. This is common in women and individuals more than fifty years of age. The majority of these individuals either did not notice any symptoms, attributed the symptoms to something insignificant or simply chose to ignore the condition. If an individual is experiencing any symptoms they believe may be related to chronic venous insufficiency, they should consult a vascular specialist as soon as possible. It is a lot safer to be cautious and discover the issue was something minor than to ignore the symptoms with the potential of great risk. The best time to consult with the specialist is as soon as the potential symptoms are observed. Ignoring this condition may result in extremely serious consequences. There are numerous different therapies available to treat this condition.
The Diagnosis of Chronic Venous Insufficiency
The two most common ways to diagnose this condition are a duplex ultrasound and a carotid duplex scan. High frequency sound waves are used by a duplex ultrasound to look at the leg vein structures and how fast the blood flow is moving. The word duplex references the two different types of ultrasound used during the procedure. These are B-mode and Doppler. The Doppler probe is contained within the transducer. This enables the direction and velocity of the blood flow within the veins to be determined. The B-mode transducer has workings similar to a microphone. The transducer provides an image of the vessel potentially causing the issue. A good example is when a carotid duplex scan is used for an assessment of the blockage, narrowing or occlusion of the carotid artery branches or the arteries located in the neck. This kind of Doppler examination was designed to provide a (2-D) 2-dimensional image of the arteries. This determines the location of an occlusion, the degree of the blood flow and the structure of the arteries.
The venogram procedure is able to visualise the veins seen in x-rays by using a contrast dye. The x-ray shows an image of the blood vessels as opaque due to the contrast dye. This enables the medical professional to evaluate both the condition and the size of the veins in addition to seeing a visualisation of the blood vessels. One of the most accurate tests used to diagnose deep vein thrombosis is the venogram. This test is also effective for diagnosing chronic venous insufficiency as well as a wide variety of abnormalities.
Medications for Chronic Venous Insufficiency
There are several different kinds of medications that can be used for the treatment of chronic venous insufficiency. A diuretic is a medication for pulling excess fluid out of the body through the kidneys. In some cases, diuretics are used to decrease swelling. Aspirin is commonly recommended to help treat and heal leg ulcers. Anticoagulation therapy uses a type of medication to thin the blood. This is usually recommended for individuals with recurring issues caused by the veins in their legs. Pentoxifylline is a medication used to trigger an improvement in the way the blood is flowing through the vessels. This medication is often used in conjunction with compression therapy to help the leg ulcers to heal.
Treatments for Chronic Venous Insufficiency
The ultimate goal for treating chronic venous insufficiency is an improvement of the blood flowing through the leg veins. These methods include:
- Decreasing the pressure in the veins in the legs by elevating the legs
- Sitting with the legs uncrossed
- Helping the blood flow and pressure on the legs by using compression stockings
- Performing exercise regularly
The physician determines the actual treatment based on
- Medical history
- Overall health
- The extent of the condition
- The age of the individual
- The tolerance of the individual for specific therapies, procedures and medications
- The expectations for the way the disease is expected to progress
- The specific symptoms and signs
- The preferences and opinion of the individual
The treatment for chronic venous inefficiency includes changes in the lifestyle of the individual such as exercise, losing weight and quitting smoking. The medical treatments are generally minimally invasive. Surgery is not recommended for ninety percent of the individuals with chronic venous insufficiency. One of the most common treatments are compression stockings. These are a type of sock designed to fit snugly around the legs. This helps optimise the flow of blood and supports the legs. Compression stockings are considered the most conservative treatment currently available. Medications including antibiotics are recommended when there is a skin infection. Other medications are often prescribed for the treatment of dermatitis, the prevention of blood clots, treating a fungus and numerous other conditions. These medications generally include topical pills or creams. In some instances, a medicated wrap called an Unna Boot is used.
Sclerotherapy is a type of injection therapy. The procedure begins by injecting medication or a special solution into the veins through a small needle. This causes a disruption in the lining of the vein. This triggers the vein to swell, shut down and close. The closed veins will be completely absorbed by the body. Sclerotherapy is also used to make varicose veins, certain vascular lesions and spider veins much lighter in colour so they become less noticeable. The body will safely and naturally start rerouting the blood flow to the healthier vessels. In the majority of cases, there is a complete disappearance of the unsightly veins. The results achieved with sclerotherapy are often dramatic and last for a long time. The individual can usually go right back to their standard routine within two hours, with absolutely no restrictions. Once the treatment has been completed, the blood vessels usually fade within six to eight weeks. In some cases multiple treatments are necessary. This is dependent on:
- The goals of the individual
- The size of the veins
- The number of veins
- The location of the veins
Anaesthesia is not required for this treatment. The majority of individuals experience a mild discomfort lasting for just fifteen to thirty seconds. The sensation has been described as a slight prick to the skin. Once the injection has been given, the veins will disappear immediately due to the blood being pushed out. The appearance of the vein will then return, but will fade as time passes. It is important to note the interconnection of so many of the vessels can result in the eradication of several dozen vessels simultaneously with just one injection. Another minimally invasive therapy used is called endovenous ablation. Laser energy or radio-frequency are used to close the targeted veins. In some cases, surgery is necessary. These instances are rare.
Surgical Procedures Used for the Treatment of Chronic Venous Insufficiency
Litigation is a surgical process for tying off the problematic vein. This prevents any blood from flowing through the vein. If there has been a lot of damage to the valves or the vein, the vein must be removed. This process is referred to as vein stripping. When the valves or the vein require surgery for repair, this is accomplished with either a long, hollow tube called a catheter or an open incision. Another option is a vein transplant. This is when a healthy vein from a different part of the body is transplanted as a replacement for the diseased vein. The Subfascial Endoscopic Perforator surgery uses a flexible, small tube with a lens and a light on the tip called an endoscope. The perforator veins are located in the calf. These veins are clipped then tied off. This enables the blood to drain into the individual’s healthy veins and improves the healing of the ulcers. This surgery is considered minimally invasive.