Venous insufficiency
Chronic venous stasis; Chronic venous disease; Leg ulcer - venous insufficiency; Varicose veins - venous insufficiency
Venous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart.
The valves in the veins usually channel the flow of blood toward the heart. When these valves are damaged, blood leaks and pools in the legs and feet. Venous insufficiency is a condition in which the veins fail to return blood efficiently to the heart. This condition usually involves one or more veins. Symptoms include swelling of the legs and pain in the extremities such as a dull aching, heaviness, or cramping.
Causes
Normally, valves in your deeper leg veins keep blood moving forward toward the heart. With long-term (chronic) venous insufficiency, vein walls are weakened and valves are damaged. This causes the veins to stay filled with blood, especially when you are standing.
Chronic venous insufficiency is a long-term condition. It is most commonly due to malfunctioning (incompetent) valves in the veins. It may also occur as the result of a past blood clot in the legs.
Risk factors for venous insufficiency include:
- Age
- Family history of this condition
- Female sex (related to levels of the hormone progesterone)
- History of deep vein thrombosis in the legs
- Obesity
- Pregnancy
- Sitting or standing for long periods
- Tall height
If you have dull, aching, or cramping pain in your legs, and pain that gets worse when you stand, you may have a condition called venous insufficiency. In venous insufficiency, the veins in your legs have trouble sending blood back to your heart. Normally, valves in your legs keep your blood flowing back towards your heart so it doesn't collect in one place. But the valves in varicose veins are either damaged or missing. This causes your veins to remain filled with blood, especially when you're standing. A blockage in your vein from a blood clot, called a deep venous thrombosis, can also cause this problem. So, how do you know if you have venous insufficiency? Well, you'll probably feel a dull aching, heaviness, or cramping in your legs. Your legs will swell up when you're on them too long. Your legs may itch or tingle. Pain will get worse when you stand, and better when you raise your legs. Your legs and ankles may also be red. You may notice skin color changes around your ankles. You may see varicose veins on the surface of your legs. You may feel thickening and hardening of the skin on your legs and ankles. So, what can you do about venous insufficiency? Well, your doctor will tell you to use compression stockings to decrease the swelling in your legs. You'll probably have to avoid long periods of sitting or standing. Even moving your legs slightly will help the blood in your veins return to your heart. Walking helps in that same way. Your doctor may recommend surgery or other treatments for varicose veins if you've tried everything and you still have leg pain that feels heavy or tired, skin ulcers or sores caused by poor blood flow. If blood clots are causing you problems, your doctor may prescribe anticoagulant or blood-thinning medicines, to treat existing blood clots and prevent others. Your doctor may suggest you try to keep your legs elevated above your heart when you lie down. You may improve your circulation through exercise. And finally, if you need to lose weight, weight loss can be a very helpful treatment of venous insufficiency and swelling.
Symptoms
Pain or other symptoms include:
- Dull aching, heaviness, or cramping in legs
- Itching and tingling
- Pain that gets worse when standing
- Pain that gets better when legs are raised
Skin changes in the legs include:
- Swelling of the legs
- Irritated or cracked skin if you scratch it
- Red or swollen, crusted, or weepy skin (stasis dermatitis)
- Varicose veins on the surface
- Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
- Wound or ulcer that is slow to heal on the legs or ankles
Exams and Tests
Your health care provider will do a physical exam and ask about your symptoms and medical history. Diagnosis is often made based on the appearance of leg veins when you are standing or sitting with your legs dangling.
A duplex ultrasound exam of your leg may be ordered to:
- Check how blood flows in the veins
- Rule out other problems with the legs, such as a blood clot
Treatment
Your provider may suggest that you take the following self-care steps to help manage venous insufficiency:
- Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
- Care for wounds if you have any open sores or infections.
- Lose weight if you are overweight.
- Exercise regularly.
You can wear compression stockings to improve blood flow in your legs. Compression stockings gently squeeze your legs to move blood up your legs. This helps prevent leg swelling and, to a lesser extent, blood clots.
When more advanced skin changes are present, your provider:
- Should explain which skin care treatments can help, and which can make the problem worse
- May recommend some drugs or medicines that may help
Your provider may recommend more invasive treatments if you have:
- Leg pain, which may make your legs feel heavy or tired
- Skin sores caused by poor blood flow in the veins that do not heal or recur
- Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
Choices of procedures include:
- Sclerotherapy -- Salt water (saline), a chemical solution, or foam is injected into the vein. The vein hardens and then disappears.
- Phlebectomy -- Small surgical cuts (incisions) are made in the leg near the damaged vein. The vein is removed through one of the incisions.
- Procedures that can be done in a provider's office or clinic, such as using a laser, radiofrequency ablation, or a technique that uses a glue/foam to seal the vein.
- Varicose vein stripping -- Used to remove or tie off a large vein in the leg called the superficial saphenous vein.
Outlook (Prognosis)
Chronic venous insufficiency tends to get worse over time. However, it can be managed if treatment is started in the early stages. By taking self-care steps, you may be able to ease the discomfort and prevent the condition from getting worse. It is likely that you will need medical procedures to treat the condition.
When to Contact a Medical Professional
Call your provider if:
- You have varicose veins and they are painful.
- Your condition gets worse or does not improve with self-care, such as wearing compression stockings or avoiding standing for too long.
- You have a sudden increase in leg pain or swelling, fever, redness of the leg, or leg sores.
References
Dalsing MC, Maleti O. Chronic venous insufficiency: deep vein valve reconstruction. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 159.
Pascarella L, Marston W. Venous disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 65.
Pascarella L, Shortell CK. Chronic venous disorders: nonoperative management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 157.
Version Info
Last reviewed on: 5/10/2022
Reviewed by: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
