�Diseases, Conditions and Injuries

Chronic Venous Insufficiency

En Espa�ol (Spanish Version)

Definition

Chronic venous insufficiency is a common condition affecting 2�5% of all Americans. This disease occurs when the valves in the veins of the legs are absent or don�t work properly. Normally, veins in the legs carry the blood from the legs to the heart. One-way valves in these veins keep the blood from flowing back into the legs. When these valves are damaged, blood pools in the legs and causes complications. Skin infections or ulcers of the legs can be recurring problems.

Venous Insufficiency

Causes

Chronic venous insufficiency can be caused by blood clots. Blood clots in the legs (called deep vein thrombosis) can damage the valves in the veins. When people get chronic venous insufficiency after a blood clot, this may be referred to as postphlebitic syndrome or postthrombotic syndrome.

Other causes of chronic venous insufficiency include:

Congenital (inherited at birth) absence or weakness of valves in the leg veins
Increased venous pressure in the legs for any reason
Varicose veins

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition.

Risk factors for chronic venous insufficiency include:

Obesity
Physical inactivity
Increased age
Family members with deep vein thrombosis
Smoking
Obesity
Pregnancy
Chronic constipation
Regularly sitting or standing for long periods of time
Wearing restrictive clothing such as very tight girdles or belts

Symptoms

When blood pools in the legs, it puts pressure on the veins. Sometimes the blood leaks out into the tissues, discoloring and damaging the skin, and even causing skin ulcers. Symptoms of chronic venous insufficiency can include:

Swelling of the legs
Pain in the legs (especially after walking), including:
- Aching
- Dullness
- Tiredness
- Cramping
Darkening of the skin on the legs (reddish or brown)
Varicose veins
Ulcers on legs, especially around the inside of the ankles
Scaling skin on legs
Hard, leathery skin on legs

Diagnosis

The doctor will ask about your symptoms and medical history and perform a physical exam. If the diagnosis is not clear from the exam or you are considering surgery, you may also have the following tests:

Duplex scanning (venous ultrasound/Doppler) � an ultrasound is a test that uses sound waves to examine the inside of the body. In this case, the blood flow in the veins in your legs is evaluated and the presence of a clot can be detected.
Venogram (x-ray of the veins) � an x-ray is a test that uses radiation to take a picture of structures inside the body. In this case, dye will be injected into a vein in your foot, and several x-rays will be taken.

Treatment

Once the valves have been damaged, they usually cannot be repaired. Treatment is ongoing and is aimed at maintaining blood flow and preventing pooling of blood. Treatment involves the following:

Elastic Support � your doctor will prescribe special elastic stockings that squeeze the veins in the legs and keep the blood from pooling.

Elevation � raise your feet and legs above the level of your heart while resting or sleeping. Your doctor may ask you to do this several times a day.

Exercise � your doctor may encourage you to walk and to do specific exercises for your legs and feet.

Movement � avoid long periods of sitting or standing. If you go on an extended trip, get up and walk or flex your leg muscles every 30 minutes or so.

Skin Care � if you have a skin ulcer, your doctor may use bandages (Unna boots) and/or apply an antibiotic cream to help prevent infection.

Surgery � surgery is reserved for the few cases where discomfort or ulcers do not respond to conservative treatment. The type of surgery recommended will depend on your particular reason for having this condition, and the results of testing.

Prevention

To help prevent chronic venous insufficiency, take steps to decrease your risk factors. These include:

Maintain a healthful weight
Exercise regularly
If you smoke, quit.
Avoid prolonged standing or sitting
Avoid wearing restrictive clothing such as very tight girdles or belts

RESOURCES:

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

Vascular Disease Foundation
http://www.vdf.org

REFERENCES:

American College of Cardiology website. Available at: http://www.acc.org/. Accessed October 12, 2005.

Beers MH and Berkow R. The Merck Manual of Diagnosis and Therapy, 17th ed. Hoboken, NJ: John Wiley & Sons; 1999.

Chronic venous insufficiency. eMedicine Journal. 2001 Nov 30.

Fauci AS, Braunwald E, Kasper DL, et al. Harrison's Principles of Internal Medicine, 15th ed. New York, NY: The McGraw-Hill Companies; 2001.

Penn State University: Milton S. Hershey Medical Center, College of Medicine website. Available at: http://www.hmc.psu.edu/healthinfo/c/chronicvenous.htm. Accessed October 12, 2005.

Last reviewed September 2005 by David Horn, MD, FACP

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