Chronic Venous Insufficiency - Causes, Symptoms, and Treatment

Introduction

The veins are a type of blood vessel that consists of an open valve on one side to allow blood flow towards the heart and prevent backflow. In a healthy individual, the blood flows from the leg toward the heart. But in patients with chronic venous insufficiency, the valves are damaged and cause blood pooling in the legs. This condition is not life-threatening but causes pain and discomfort to the patient.

What Is Chronic Venous Insufficiency?

Chronic venous insufficiency is a valvular disease that involves the lower extremities causing swelling, irritation, and a poor quality of life. If the condition is left untreated, it progresses to form ulcers and worsen the disease process. Hence, the doctor advises the patient for a few lifestyle modifications, compression therapy, or management by a surgical procedure.

What Are the Reasons for Chronic Venous Insufficiency to Occur?

Chronic venous insufficiency can be classified into primary and secondary forms.

• Primary chronic venous insufficiency occurs without any precipitating risk factors. It occurs due to a change in the vessel wall integrity or a congenital defect (a disease that has been present since birth). Most chronic venous insufficiency patients have the primary form of the disease.

• The secondary form is due to the formation of deep vein thrombosis (a blood clot formed in the deep veins of the leg). The thrombus or blood clot leaves scar tissue that causes inflammation and injures the vein.

Who Is More Likely to Develop Chronic Venous Insufficiency?

Certain risk factors make the patient more likely to develop the disease. They are:

• A patient with a previous history of deep vein thrombosis.

• Presence of varicose veins or with a family history of varicose veins.

• In older adults above fifty years of age.

• Obesity.

• Female.

• Pregnancy.

• The habit of smoking and alcohol.

• In patients who sit or stand for a long time.

• Phlebitis (swelling of a superficial vein).

• A person with very little physical activity.

• Weak muscles in the leg.

• Trauma to the leg region.

• In patients with May-Thurner syndrome (a condition that compresses a vein in the leg and obstructs the blood flow).

What Are the Signs and Symptoms of Chronic Venous Insufficiency?

The symptoms vary from one person to another. Not all of the following symptoms are present. They develop one by one, depending on the patient’s condition. The signs and symptoms include:

• Pain in the legs that worsens on standing and is relieved on raising the leg.

• Swelling of the leg and ankle.

• A burning or tingling sensation in the legs.

• Reddish-brown skin discoloration.

• Itchy and weak legs.

• Leg cramps.

• Heaviness in the legs.

• A feeling of tightness in the calf muscles.

• A leathery appearance of skin in the legs.

• Ulcers may develop in the legs if left untreated.

• Varicose veins (dilated and tortuous veins).

What Are the Phases of Chronic Venous Insufficiency?

Venous disorders can be categorized into six stages according to their clinical signs and symptoms.

• Stage 0: No symptoms. The patient only has a feeling of tired or heavy legs.

• Stage 1: The veins become dilated and tortuous, giving the appearance of a spider web (spider veins).

• Stage 2: Varicose veins of at least three millimeters in width.

• Stage 3: Swelling of the legs.

• Stage 4: Skin discoloration and change in the skin texture.

• Stage 5: Development of an ulcer.

• Stage 6: Ulcer that has become infected.

Generally, a person is diagnosed with chronic venous insufficiency when they reach stage 3. The patients must not confuse varicose veins with chronic venous insufficiency. Varicose veins may progress into chronic venous insufficiency; hence the doctor must be consulted at the early stages to prevent further complications.

What Are the Investigations Done to Diagnose Chronic Venous Insufficiency?

The doctor records a detailed history of the patient and does a physical examination of the leg. The signs of chronic venous sufficiency, if present, are noted. Additional imaging tests will be required to confirm the diagnosis. The imaging tests include:

• Venogram - An intravenous radiocontrast dye is injected into the vein to make the veins appear opaque on a radiograph. This helps to visualize the blood vessel configuration and detect any damage in the wall of the veins.

• Duplex Ultrasound - An imaging technique that uses sound waves to determine the speed and direction with which the blood flows through the veins. In this procedure, a transducer (a hand-held device used to transmit the signals) is placed on the skin, records the blood flow, and displays the image on a computer.

What Are the Treatment Modalities Available for Chronic Venous Insufficiency?

Various treatment protocols are available, ranging from lifestyle modification to surgical options. Whatever the treatment option, the main aim is to relieve the pain, improve the blood flow in the veins and provide an esthetic appearance to the skin.

Lifestyle Modifications: The first line of treatment tried for all patients.

• Exercise - The patient is advised to walk daily and perform exercises for at least a few minutes. This helps to strengthen the calf muscles and improves the blood flow to the heart.

• Elevating the Legs - Lifting the leg upwards helps push the blood toward the heart and decreases the blood pooling in the legs. The patient is advised to perform leg elevation at least three times daily.

• Compression Stockings - These are tight elastic bands worn by the patient to reduce the swelling in the legs and relieve the discomfort.

• Weight Loss - It is advisable for the patients to lose weight to decrease the load on the legs. A diet plan can be discussed with the patient, and advised to avoid foods that increase weight.

• Maintaining Skin Hygiene - The doctor advises the patient to wash the legs and keep them moisturized using a lotion or an ointment. It prevents any itchiness and dryness of the skin.

Non-Surgical Treatment:

• Ablation - By the application of heat or chemicals, the affected veins are destroyed or sealed off.

• Laser Therapy - A laser beam is used to seal off the damaged veins.

• Sclerotherapy - The doctor injects a liquid or foam into the affected veins, which swell and get closed. After a few days, the body tries to absorb this vein, and the blood flow is redirected to the healthy vein.

Surgical Treatment:

• Phlebectomy - A minor procedure in which a small needle is used to remove the superficial veins of the leg.

• Vein Ligation and Stripping - A surgical procedure to cut and tie the damaged vein. The affected vein is then stripped off using small incisions.

• Stent - An implant or a stent is placed in the damaged vein to widen the narrow vein and improve blood flow.

• Vein Bypass - When none of the above treatments are effective, the surgeon tries to bypass the damaged vein and reroute the blood flow through the nearby healthy vein.

It is up to the doctor’s decision and the patient’s condition to identify which treatment modality suits them. For all patients, managing chronic venous insufficiency is started with lifestyle changes followed by non-surgical or surgical treatment if the symptoms persist.

Conclusion

Chronic venous insufficiency is not a disease to be worried about. But, if left untreated, it can lead to many complications leading to ulcer formation and disability of the patient. There are numerous management strategies available to treat this condition. Lifestyle changes do not entirely cure the damaged veins; they only provide symptomatic relief. For a permanent solution, the veins can be managed by either the surgical or non-surgical procedure, depending on the patient’s condition.