- Chronic Venous Insufficiency
- What causes chronic venous insufficiency?
- What are the symptoms of chronic venous insufficiency?
- How is chronic venous insufficiency diagnosed?
- What is the treatment for chronic venous insufficiency?
- Explore Your Options for Chronic Venous Insufficiency Treatment
- What Is Chronic Venous Insufficiency?
- Stages of Chronic Venous Insufficiency
- Noninvasive Chronic Venous Insufficiency Treatments
- Minimally Invasive Chronic Venous Insufficiency Treatments
- The Top 6 Risk Factors for Chronic Venous Insufficiency
- What is chronic venous insufficiency?
- What causes it?
- Hormone changes (including menopause and pregnancy)
- Sedentary lifestyle
- How do I know if I have it?
- How can I treat it?
- Elevating your legs.
- Compression stockings.
- Chronic Venous Insufficiency: What to Know
- Venous insufficiency: Straight talk about ‘silent disease’
- Venous Ulcers
- Causes of venous ulcers
- Caring for venous ulcers
- Preventing venous ulcers
- Chronic Venous Insufficiency Symptoms and Complications
- Chronic Venous Insufficiency Symptoms
- Venous Ulcers
- Blood Clots
- Understanding Your Treatment Options
- Noninvasive Treatments
- Minimally Invasive Treatments
Chronic Venous Insufficiency
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Chronic venous insufficiency occurs when your leg veins don’t allow blood to flow back up to your heart. Normally, the valves in your veins make sure that blood flows toward your heart. But when these valves don’t work well, blood can also flow backwards. This can cause blood to collect (pool) in your legs.
If this condition is not treated, you may have:
- Skin changes
- Varicose veins
- Leg ulcers
Chronic venous insufficiency is not a serious health threat. But it can be painful and disabling.
What causes chronic venous insufficiency?
You are more ly to have this condition if you:
- Are overweight
- Are pregnant
- Have a family history of the problem
- Had damage to your leg due to injury, surgery, or previous blood clots
Other causes of chronic venous insufficiency include:
- High blood pressure in the leg veins over time, due to sitting or standing for long periods
- Lack of exercise
- A blood clot in a deep vein, often in the calf or thigh (deep vein thrombosis)
- Swelling and inflammation of a vein close to the skin, often in the legs (phlebitis)
What are the symptoms of chronic venous insufficiency?
Symptoms of chronic venous insufficiency may include:
- Swelling in your legs or ankles
- Tight feeling in your calves or itchy, painful legs
- Pain when walking that stops when you rest
- Brown-colored skin, often near the ankles
- Varicose veins
- Leg ulcers that are sometimes hard to treat
- Having an uncomfortable feeling in your legs and an urge to move your legs (restless legs syndrome)
- Painful leg cramps or muscle spasms (charley horse)
The symptoms of chronic venous insufficiency may seem other health conditions. Talk with your healthcare provider for a diagnosis.
How is chronic venous insufficiency diagnosed?
Your provider will take your medical history and give you an exam. You may also have an imaging test called a Duplex ultrasound. This looks at blood flow and the structure of your leg veins. It checks the speed and direction of blood flow in the blood vessel.
What is the treatment for chronic venous insufficiency?
Your healthcare provider will create a treatment plan for you :
- Your age, overall health, and medical history
- How serious your case is
- How well you handle certain medicines, treatments, or therapies
- Your signs and symptoms
- If your condition is expected to get worse
- What you would to do
Treatment may include:
- Improving blood flow in your leg veins. Keeping your legs raised (elevated) can reduce swelling and help increase blood flow. Wearing compression stockings may also help. Regular exercise can also improve blood flow.
- Medicines. Medicines that increase blood flow through the vessels may be used along with compression therapy to help heal leg ulcers. Aspirin can also be used to help ulcers heal. Medicines that draw excess fluid from the body through the kidneys (diuretics) are not often used. But they may be used if other conditions such as heart failure or kidney disease are also linked to the swelling.
- Endovenous laser ablation or radiofrequency ablation (RFA). This is a minimally invasive procedure. A tube (catheter) puts heat right into the affected vein. This closes the vein. Once the vein is closed, less blood pools in the leg. Overall blood flow is improved.
- Sclerotherapy. This may be used if your case is more serious. A chemical is injected 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. The body absorbs the scarred veins.
- Surgery. This is done in severe cases. Ligation is a type of surgery that may be used. The affected vein is tied off so that blood no longer flows through it. If the vein or its valves are heavily damaged, the vein will be removed. This is called vein stripping.
Explore Your Options for Chronic Venous Insufficiency Treatment
If you have chronic venous insufficiency, you don’t have to suffer alone. Modern treatments can help resolve your symptoms and prevent your condition from progressing. Minimally invasive procedures close off malfunctioning veins and improve blood flow without an overnight hospital stay. Read on to learn more about your options for chronic venous insufficiency treatment.
What Is Chronic Venous Insufficiency?
Chronic venous insufficiency is a vascular condition which develops when the valves in your veins do not function properly. In healthy veins, valves direct blood flow.
They return deoxygenated blood from your legs back to your heart. Sometimes, these valves become damaged and do not work as well as they should.
Instead of returning all deoxygenated blood back to the heart, some blood may flow backward into the legs. (i)
Over time, chronic venous insufficiency causes the veins in the legs to become swollen and distended. Backed-up blood flow can weaken the malfunctioning veins even further. Chronic venous insufficiency is a progressive disease.
(ii) That means it becomes worse if it’s not treated. The condition is also sometimes linked with blood clots, which can cause dangerous health complications.
That’s why it’s crucial to seek early treatment for your chronic venous insufficiency.
Stages of Chronic Venous Insufficiency
The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system categorizes chronic venous insufficiency symptoms. (iii) Doctors use this classification scale to determine how severe your symptoms are and what kind of treatment you might need.
- C0 Stage: Patients at this stage might have some symptoms, heaviness or aching in the legs, but no visible signs of chronic venous insufficiency. This is the least severe stage.
- C1 Stage: Patients at this stage have thin visible veins that may resemble spider webs. Chronic venous insufficiency may be present if other symptoms such as pain, swelling or heaviness in the legs are present.
- C2 Stage: Patients at this stage have visibly dilated leg veins. Patients may have painful varicose veins.
- C3 Stage: Patients at this stage suffer from edema, or swelling, in the legs and feet. Increased vascular pressure causes fluid to seep from the vein into the surrounding leg tissue. Legs, ankles, and feet may appear puffy or bloated.
- C4 Stage: Patients at this stage often have visibly discolored or inflamed skin. The legs and ankles may appear brownish. The skin may also have red splotches. Some regions of the legs may look scarred or rashy.
- C5 Stage: Patients at this stage have signs of healed ulcers on the legs.
- C6 Stage: Patients at this stage have “active” or open venous ulcers. Ulcers may be swollen or weeping and might become infected. This is the most severe stage.
If a patient begins to develop ulcers, it’s a sign that there’s not enough blood flowing to the legs. When blood flow to the legs is limited, blood clots can form. Infected ulcers may also require surgery or antibiotics. Chronic venous insufficiency treatments can prevent these complications.
Noninvasive Chronic Venous Insufficiency Treatments
In the early stages of chronic venous insufficiency, you might be able to manage your symptoms with conservative treatment strategies, which may include lifestyle changes or other at-home treatments: (iv)
- Elevate your legs: When sitting or lying down, elevate your legs. This helps relieve pressure inside the veins and promotes circulation.
- Maintain good skin hygiene: People with chronic venous insufficiency are at high risk of developing venous ulcers. These sores may become infected. You can prevent infection by keeping your skin clean. Your doctor will tell you how to keep the ulcer from becoming infected. (v) If you suffer from venous insufficiency don’t use any skin creams or bath products without your doctor’s approval.
- Avoid sitting and standing for too long: Symptoms may worsen if you sit or stand for long periods of time. Try to take regular breaks and elevate your feet to reduce blood pressure in your legs. If your job requires you to stand or sit for many hours at a time, you may find it helpful to wear compression stockings.
- Exercise regularly: Regular exercise keeps blood flowing throughout the legs. Healthy blood flow can reduce your risk of complications venous ulcers. Walking can be particularly beneficial for people with chronic venous insufficiency. Ask your doctor which physical activities are safest for you.
- Consider compression stockings: Compression stockings fit snugly around your legs. They help improve circulation by preventing blood from flowing backward. This can reduce leg pain and swelling in people with chronic venous insufficiency. Ask your doctor before using compression stockings for the first time.
- Maintain a healthy weight: Excess body weight puts additional pressure on the veins in the legs. Extra pounds can worsen chronic venous insufficiency. If you’re overweight, ask your doctor about safe weight loss methods.
Conservative treatment may be enough to provide relief. If your symptoms worsen, it’s essential that you seek help. A vascular specialist can offer minimally invasive techniques to treat your symptoms and prevent future complications.
Minimally Invasive Chronic Venous Insufficiency Treatments
Minimally invasive procedures can prevent blood from flowing backward in the vein and decrease venous pressure, restoring healthy blood flow to the legs. Treatments for chronic venous insufficiency may include: (vi)
- Radiofrequency vein ablation (RVA): RVA uses a tiny catheter to deliver radiofrequency energy into the vein, closing it off. Once the vein is no longer supporting blood flow, it will shrink and be reabsorbed by your body.
- Endovenous laser therapy (EVLT): EVLT is a similar process to RVA. Instead of radiofrequency energy, EVLT uses laser energy to close the affected vein and seal off blood flow. As with RVA, the vein will then shrink and disappear.
- Sclerotherapy: Sclerotherapy uses a medication which is injected into the affected vein. The medicine irritates the tissue and causes scarring. The scarring cuts off blood flow, causing the vein to shrink and fade away.
- Angioplasty and Venous Stripping: If your symptoms are more severe, your vascular specialist may recommend angioplasty or venous stripping. Angioplasty can help open a blocked vein, whereas venous stripping is the removal of a malfunctioning vein.
It can be tempting to put off chronic venous insufficiency treatment. But if you delay treatment, your condition may worsen. Minimally invasive procedures can provide symptomatic relief and get you back to your daily routine quickly. Ready to speak to a doctor about your treatment options? Call 844-832-VEIN (8346) to schedule an appointment with a vascular specialist.
Sources: (i) John Hopkins Medicine. Chronic venous insufficiency. Retrieved October 1, 2018, from https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/chronic_venous_insufficiency_85,P08250. (ii) MedlinePlus. (2016, June 6). Venous insufficiency.
Retrieved October 1, 2018, from https://medlineplus.gov/ency/article/000203.htm. (iii) Moneta, G. (2018, April 19) Classification of lower extremity chronic venous disorders. In K.A. Collins (Ed.), UpToDate. Retrieved October 1, 2018. https://www.uptodate.
com/contents/classification-of-lower-extremity-chronic-venous-disorders?csi=cc3253bf-f8bb-4f0e-a8f8-7a6bd7513422&source=contentShare%20. (iv) https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi/treatment-options. (v) MedlinePlus. (2016, May 24). Venous ulcers – self-care.
Retrieved October 1, 2018, from https://medlineplus.gov/ency/patientinstructions/000744.htm.
(vi) Mayo Clinic. (2017, December 28). Varicose veins: Diagnosis & treatment. Retrieved October 1, 2018, from https://www.mayoclinic.org/diseases-conditions/varicose-veins/diagnosis-treatment/drc-20350649.
The Top 6 Risk Factors for Chronic Venous Insufficiency
This disorder is something that, a matter of just a few years ago, oftentimes went undertreated. The lack of treatment for chronic venous insufficiency was a result of a few things:
- Lack of technology
- Lack of education/knowledge
- Lack of awareness
However, within the last 10 years, much research has been conducted on this vein disorder that affects a large portion of the population, primarily females.
As a result of that research, more awareness has been raised and more knowledge has been gained. This all has come at a time when technological advances in the medical world are at an all-time high and seem to keep getting better.
Here, we dive into chronic venous insufficiency and how it changes your body — because one of the best ways to put yourself at low risk of developing this disease or avoiding it altogether is to understand what it is, and what to look out for.
What is chronic venous insufficiency?
Let’s start with the basics. Chronic venous insufficiency according to Johns Hopkins Medicine, something that “occurs when your leg veins don’t allow blood to flow back up to your heart.”
They go on to say that “normally, the valves in your veins make sure that blood flows toward your heart. But when these valves don’t work well, blood can also flow backward. This can cause blood to collect (pool) in your legs.”
What causes it?
most vein problems, there are a number of reasons a person may develop vein issues such as chronic venous insufficiency.
The top reasons for developing chronic venous insufficiency include:
Obesity puts people at risk of developing a number of health problems. Heart issues steal the spotlight and most people do not think about the fact that obesity can wreak havoc on your veins, too.
The amount of weight and pressure that your veins fall victim to when you’re obese makes it difficult for them to function normally. Your veins are not able to return the blood through your body, back to your heart, as they normally do, which leaves that blood to pool in your legs and other places as well.
Hormone changes (including menopause and pregnancy)
Changes in hormones are another major risk factor for venous insufficiency. And the most common time to see these shifts in hormones is during pregnancy.
Unfortunately, with each pregnancy your chances of having vein issues increases. There is a great deal more pressure put on your veins when you are pregnant, so chances are higher that you may find yourself suffering from weakened or damaged veins.
Specifically, over the age of 50. Unfortunately, it is just part of aging that your veins will weaken over time. Think about it — they have been used more than, say, a 20-year-old’s veins, so they don’t have the strength that the veins of someone younger do.
Thus, the older you are, the more at risk you are of developing venous insufficiency due to the weakening of your veins and the increased struggle for your veins to return the blood back up to your heart.
Unfortunately, you can’t fight your genes. Some people can have a genetic predisposition to develop vein issues, and there is just no way around it.
You can help make your venous insufficiency issues less severe if you know ahead of time that you are at a higher risk for problems, and do your best to step up your health in other areas of your life.
One of the biggest risk factors for chronic venous insufficiency is the lack of body movement. Sitting or standing too much is horrific for your all-around health, but for your veins in particular. The longer you stay in one place (whether that’s standing or sitting), the harder it is for your body to properly pump your blood.
Because your veins are fighting against gravity to pump blood back up to your heart, it’s important you help out a bit and get moving so that your veins don’t have to work at their maximum all the time.
Another reason a sedentary life is risky when it comes to your vein health is that the more sedentary you are, the more ly you are to suffer from weight gain. And, as mentioned above, that weight gain is not going to be good for your veins.
a number of the things mentioned above, smoking does damage to your health in a number of ways including something most people don’t think about — yep, you guessed it: your veins. Smoking leads to the weakening of your veins walls, which means you are at a higher risk of venous insufficiency.
You have to keep those lungs and those vein walls strong!
How do I know if I have it?
The only way to be 100% sure that what you have is indeed chronic venous insufficiency, you would need to schedule a consultation with a vein specialist.
If you do have chronic venous insufficiency, here are some things you’ll notice.
The most common change you will experience is dilated veins. Your veins will widen with this disorder and will appear as either spider veins — blue, thin veins — or varicose veins — wider veins on the surface.
Swelling is also something that chronic venous insufficiency will bring about.
This swelling can either be something that you suffer throughout the day or simply at the end of the day when you finally give your legs a rest.
However, note that swelling is most often at its lowest intensity in the morning, due to the fact that elevating your legs (as you do while sleeping), causes swelling to go down.
The change in the color of your legs is something you should expect as well. This happens because weakened veins cause the blood in your legs to pool, which then causes your skin to become inflamed. This inflammation can take the form of:
- Open sores
- Fluid oozing
- Hard, shiny areas
And, ulcers, they don’t sound pretty, and sure aren’t pretty either. These ulcers are most commonly found on the ankle but sometimes occur on the shin as well.
These ulcers are essentially sores that are open, and will not heal for months, possibly even years. They are painful and certainly uncomfortable and have been known to ooze fluid often.
How can I treat it?
If you’re faced with chronic venous insufficiency, chances are good you’re curious how you can treat it. Well, on your own, the best way to handle this disorder is to do what you can to lessen the severity of the symptoms.
Here are some things you can try to help treat chronic venous insufficiency:
Elevating your legs.
With just 30 minutes a few times a day of elevating, you’ll find a decrease in the swelling of your legs and see your blood flow improve.
By elevating your legs, you are helping your venous ulcers to improve. People with mild chronic venous insufficiency find that elevating their legs may be all the treatment they need, while people who suffer from a more severe form of the disorder may need additional treatment.
Depending on the severity of your chronic venous insufficiency, you may be able to get stockings just over the counter at the drugstore. If your disorder is more serious, you’ll need prescription-level stockings.
These stocking work to compress your leg so that your blood flow is able to improve and flow more smoothly, thus avoiding pooling.
This is for more serious cases of chronic venous insufficiency, but don’t worry — it is not a major surgery. At Vein Clinics of America, we perform sclerotherapy on a regular basis, and our patients have incredible success with it.
The procedure simply involves injecting the vein with something that causes it to collapse. While the damaged vein remains in your leg, it is no longer responsible for trying to carry your blood, so it will no longer suffer and cause you trouble.
Chronic Venous Insufficiency: What to Know
- Chronic Venous Insufficiency
- How to Improve Circulation
The veins in your legs carry blood back to your heart.
They have one-way valves that keep blood from flowing backward. If you have chronic venous insufficiency (CVI), the valves don’t work they should and some of the blood may go back down into your legs.
That causes blood to pool or collect in the veins.
Over time, CVI can cause pain, swelling, and skin changes in your legs. It may also lead to open sores called ulcers on your legs.
A blood clot in a deep vein in your leg (called deep vein thrombosis) can damage a valve. If you don’t exercise, that can cause CVI, too. So can sitting or standing for long stretches of time. That raises pressure in your veins and may weaken the valve.
Women are more ly than men to get CVI. Your chances also might be higher if you are:
- Over age 50
- Pregnant or have been pregnant more than once
- From a family with a history of CVI
- Someone with history of blood clots
- A smoker
You may notice these in your legs:
- Swelling or heaviness, especially in the lower leg and ankle
- Varicose veins (twisted, enlarged veins close to the surface of the skin)
- Skin that looks leather
Without treatment, the pressure and swelling will burst the tiny blood vessels in your legs called capillaries. That could turn your skin reddish-brown, especially near the ankles. This can lead to swelling and ulcers. These ulcers are tough to heal. They are also more ly to get infected, which can cause more problems.
If you have any of the symptoms of CVI, talk to your doctor. The sooner you treat it, the less ly you’ll get ulcers.
Your doctor will take your medical history. They then will check the blood flow in your legs with a test called a vascular or duplex ultrasound. Your doctor will place a small device on your skin over the vein. Using sound waves, they can see the blood vessel and check how quickly and in what direction the blood flows.
Sometimes, you may need X-rays or specific scans to check for other causes of your leg swelling.
The main goal is to stop swelling and prevent leg ulcers. Your doctor may suggest a combination of treatments your age, symptoms, and other things. Some options to help manage CVI include:
You can help blood flow better in your leg veins. Steps include:
Compression stockings. These elastic socks put pressure on your legs to help blood move. They come in different tightnesses, lengths, and styles. Your doctor can suggest which might work best for you.
Movement. Try not to sit or stand for a long time. If you have to sit for a while, stretch or wiggle your legs, feet, and ankles often to help your blood flow. If you stand a lot, take breaks to sit and put your feet up. This helps lower pressure in your leg veins.
Exercise. Working out your body helps pump your blood, too. Walking is a good, simple way to make your legs stronger and boost blood flow.
Your doctor may prescribe an antibiotic to treat infections or leg ulcers. Sometimes, they’ll give you medicine to help prevent blood clots.
If your CVI is further along, you may need a nonsurgical treatment.
Sclerotherapy . You doctor will inject a solution into the problem vein. It scars the vein, forcing blood to flow through healthier veins. Over time, your body absorbs the scarred vein.
Endovenous thermal ablation. This newer method uses high-frequency radio waves or a laser to heat and close the problem vein.
Fewer than 1 in 10 people need surgery for CVI.
Ligation. The vein is cut and tied off so blood can’t flow through. Your doctor may also remove a vein that is very damaged. You usually will go home on the same day.
Vein repair. Your doctor fixes the vein or the valves. This can be done through an open cut on your leg or through a smaller opening by using a long, hollow catheter or tube.
Vein transplant. Your doctor replaces the problem vein with a healthy one from somewhere else in your body.
Vein bypass. This is done on veins in the upper thigh and only in the most severe cases. Your doctor takes part of a healthy vein from another part of your body. She’ll use that to reroute blood around the affected vein. You’ll usually stay in the hospital for 2-5 days.
Johns Hopkins Medicine: “Chronic Venous Insufficiency.”
Cleveland Clinic: “Chronic Venous Insufficiency (CVI).”
Society for Vascular Surgery: “Chronic Venous Insufficiency.”
Vascular Cures: “Chronic Venous Insufficiency.”
© 2018 WebMD, LLC. All rights reserved. How to Improve Circulation
Venous insufficiency: Straight talk about ‘silent disease’
Venous insufficiency, says vascular and endovascular surgeon Dr. Hadi Shalhoub, is “the silent disease.”
That is probably one reason he is so vocal about it. Another is that, by his count, “70 to 80 percent of patients who come into [Sebastian’s] Wound Care Center with a chronic wound come in with a venous insufficiency.”
According to Johns Hopkins Medicine, “venous insufficiency occurs when your leg veins don’t allow blood to flow back up to your heart. Normally, the valves in your veins make sure that blood flows toward your heart.
But when these valves don’t work well, blood can also flow backwards. This can cause blood to collect (pool) in your legs.
If this condition is not treated, you may have pain, swelling, cramps, skin changes, varicose veins and leg ulcers.”
It’s all about those tiny valves inside your veins, according to Shalhoub, a member of the Steward Medical Group.
If those valves fail, it can – and usually does – cause blood pressure to build up in the legs. That increase in pressure prevents nutrients and oxygen from getting to tissues, causing cells to die and wounds to form.
In a worst-case scenario, your blood, blocked by one of those faulty valves, may thicken into a mass that becomes solid, forming a clot that potentially can travel to one of your lungs and make breathing difficult or even cause death.
The National Institutes of Health points out that fully 10 percent of the U.S. population has some type of vascular problem and ones venous insufficiency are generally considered to be hereditary. You may have been born with a predisposition for developing it.
Unfortunately, there’s no take-home sphygmomanometer (blood pressure cuff) available to self-diagnose venous insufficiency. To spot the signs of a potential problem, people should look for signs such as small spider veins or “a very visible blood vessel that dilates and shows on somebody’s leg.”
Asked how venous insufficiency is confirmed and treated, Shalhoub says “every patient usually has a full clinical evaluation and we find out whether there are other abnormalities to their vein structure.
Sometimes the heart has to be evaluated also, because if the pump is not working and it causes backup pressure onto the lower veins, that can cause swelling in the legs too, and that has to be understood.”
A key part of this evaluation is a highly specialized form of ultra-sound called a “VNUS Grade Doppler” which, Shalhoub explains, “is designed to visualize all of these valves and grade them to see if they are incompetent.”
If they are, don’t look for Shalhoub to break out his prescription pad. There are, he states, “very few medications” that can successfully treat this particular problem.
Instead, it’s more ly Shalhoub will close-off the malfunctioning vein and valve and allow other nearby veins to take over.
“Once the [damaged] vein is closed, less blood pools in the leg, and overall blood flow is improved,” according to University of Rochester Medical Center.
“We figured out if we close [the veins with malfunctioning valves], they do actually improve the symptoms in the legs,” Shalhoub says.
“The nice thing about this procedure is that it’s an office-based procedure where an ultrasound technician comes and scans the veins and we enter the vein percutaneously with the needle stick, without any sight of blood.
I mean it’s starting an IV. And a catheter is placed inside the vein and monitored under ultrasound for its positioning.
“The catheter,” Shalhoub continues, “is used with radio frequency that generates an amount of heat that brings this vein to a close.”
Pausing, he firmly states, “radio frequency ablation is the superior method of taking care of this problem.”
Dr. Hadi Shalhoub is with Advanced Surgical Associates and the Steward Medical Group. His office is at 13100 U.S. 1 in Sebastian. The phone number is 772-581-8900.
Ulcers are open skin sores. They can affect any area of the skin. But they most often occur on the legs. Venous ulcers are leg ulcers caused by problems with blood flow (circulation) in your leg veins.
Normally, when you get a cut or scrape, your body's healing process starts working to close the wound. In time, the wound heals. But ulcers may not heal without proper treatment.
Causes of venous ulcers
Venous ulcers most often form around the ankles.
Venous ulcers typically occur because of damage to the valves inside the leg veins. These valves control the blood pressure inside the veins. They allow it to drop when you walk. If the blood pressure inside your leg veins doesn't fall as you're walking, the condition is called sustained venous hypertension. That increase in blood pressure causes ulcers to form on your ankles.
Venous ulcers may also be caused by other problems with your leg veins. These include:
- Varicose veins. These are large, bulging leg veins. They occur when valves in the leg veins don’t work well, allowing blood to collect (pool) in the lower leg.
- Chronic venous insufficiency. varicose veins, this condition occurs when your leg veins can’t pump blood back up to your heart. Blood then pools in your lower legs, causing your legs to swell. Since the blood can't flow well in your legs, the swelling may be extreme. This extreme swelling can put so much pressure on your skin that venous ulcers form.
Caring for venous ulcers
Venous ulcers need proper care and treatment to prevent infection and to heal. It's important to have any venous ulcers checked right away by your healthcare provider.
Treatment may require focusing on the circulatory or vein problems that are causing the ulcers. Or it may mean removing some tissue around the wound. You may be asked to:
- Clean the wound regularly
- Apply a dressing to the ulcer
- Avoid products that cause skin sensitivity
- Wear compression stockings to prevent blood from pooling in the legs and to speed healing
- Apply an antibacterial ointment or another topical medicine to prevent or treat an infection
- Take oral antibiotic medicines to prevent or treat an infection
- Have allergy testing done
Wearing a compression wrap to keep blood flowing back up to your heart can also help ulcers heal more quickly. In some cases, surgery or a skin graft is needed to close up the opening in the skin.
Preventing venous ulcers
To prevent venous ulcers, you first need to prevent vein problems. You can do this by having healthy habits that help the blood flow in your legs. These lifestyle changes can improve your circulation and reduce the risk for venous ulcers:
- Avoid smoking
- Lose weight if you're overweight or obese
- Stay at your ideal weight
- Get plenty of regular exercise
- Move around often
- Raise (elevate) your legs for a short time, especially if you've been standing all day
Wearing compression stockings can also help. They can:
- Prevent blood from pooling in your legs
- Help you avoid significant swelling
- Reduce your risk for venous ulcers
Chronic Venous Insufficiency Symptoms and Complications
You may think of varicose veins as merely a cosmetic nuisance but your varicose veins could be a symptom of a more serious venous condition. If you have swollen leg veins or a heavy, aching sensation in the legs, don’t ignore these signs.
They could be symptoms of chronic venous insufficiency. A vascular specialist can determine whether you’re at risk for this condition. If you do have chronic venous insufficiency, treatment can help relieve your symptoms and may prevent complications.
Chronic Venous Insufficiency Symptoms
One of the earliest symptoms of chronic venous insufficiency is varicose veins. These veins typically appear in the lower legs. Varicose veins symptoms can include: (iv)
- Dark blue or purple veins
- Twisted or bulging veins
- Sore, achy legs
As chronic venous insufficiency progresses, patients may also experience the following symptoms in their legs: (v)
- Aching sensation
- Brownish skin
In its later stages, chronic venous insufficiency often causes changes in the texture of your skin. Your lower legs may look blistered or scaly. You might also have open sores that bleed or weep.
Early symptoms of chronic venous insufficiency, achy legs, might not seem serious. If left untreated, the condition may progress.
Serious complications can arise from untreated chronic venous insufficiency.
Poor circulation in the legs can cause ulcers to develop. These ulcers may be painful and slow to heal. Even with treatment, it can take months for an ulcer to disappear. If they’re not kept clean during the healing process, these ulcers can quickly become infected. (ii)
If a venous ulcer becomes infected, your doctor may need to debride the wound to remove infected tissue. (vi) You may also need to take oral antibiotics. Infected ulcers must be treated right away. An untreated infection may require surgery. (vi) However, swift treatment can usually resolve the infection and prevent further complications.
Reduced blood flow in the legs can also trigger the formation of blood clots. Chronic venous insufficiency is sometimes linked to deep-vein thrombosis (DVT). (i) DVT develops when a blood clot forms in one of the deep veins in your legs.
These clots can block blood flow to the leg and in some cases, may cause a pulmonary embolism. (vii) Pulmonary embolisms can occur when part of a blood clot in the leg breaks off and travels to the lungs.
The clot can then block the arteries in your lungs and keep you from getting enough oxygen. Pulmonary embolisms can be fatal.
(vii) Symptoms of pulmonary embolism include coughing up blood, feeling pain or discomfort in the chest, experiencing shortness of breath, and having low blood pressure and an elevated heartbeat. (vii) If you suspect a pulmonary embolism, call 911 immediately.
Circulation problems can affect your ability to heal from injuries. If you have chronic venous insufficiency and injure your leg, you may bleed heavily. Immediate care might be needed to stop this bleeding. Uncontrolled blood loss can sometimes be life-threatening.
Some people with chronic venous insufficiency may bleed spontaneously. (iii) This might occur due to a venous ulcer or a hemorrhaging vein. Any unexplained or heavy bleeding should be reported to a doctor right away.
Understanding Your Treatment Options
Chronic venous insufficiency symptoms are often painful. They may limit your ability to keep up with your job or other daily activities. The condition can also lead to dangerous health complications. But early treatment can help keep your veins healthy for as long as possible.
If you’re diagnosed with chronic venous insufficiency, you have several treatments options. Some chronic venous insufficiency treatments involve lifestyle changes. Others may require minimally invasive procedures or more extensive treatment to resolve venous ulcers or other complications. A vascular specialist can help you develop a treatment strategy that meets your needs.
Noninvasive treatments can help make you more comfortable. They can also help prevent your condition from becoming worse. Many noninvasive treatments focus on managing symptoms and reducing pain. Your doctor may suggest that you: (viii)
- Elevate your legs
- Wear compression stockings
- Get regular exercise
- Maintain a healthy weight
- Avoid sitting/standing for long periods
It’s essential that people with chronic venous insufficiency maintain good hygiene and care for the skin on their legs. If you experience scaling, itching, or flaking skin, your doctor may recommend special topical creams to ease these symptoms. Your doctor will also tell you how to care for venous ulcers to promote healing and prevent infection.
Minimally Invasive Treatments
If noninvasive treatments aren’t providing enough relief, however, your doctor may recommend a minimally invasive procedure to improve blood flow to the legs.
These minimally invasive treatments can be performed in an outpatient setting: (viii)
- Radiofrequency vein ablation
- Endovenous laser therapy
These procedures work to address the underlying cause of chronic venous insufficiency: malfunctioning valves in the veins. These treatments close off the affected veins, causing them to shrink and disappear. (i) Blood flow is then redirected to healthy veins.
Chronic venous insufficiency symptoms can be alarming but prompt treatment may prevent complications and get you back on your feet. Call 844-832-VEIN (8346) to schedule an appointment with a vascular specialist today.
Sources: (i) John Hopkins Medicine. (n.d.). Chronic venous insufficiency. Retrieved October 1, 2018, from https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/chronic_venous_insufficiency_85,P08250. (ii) MedlinePlus. (2016, May 24). Venous ulcers – self-care. Retrieved October 1, 2018, from https://medlineplus.
gov/ency/patientinstructions/000744.htm. (iii) Alguire, P. & Scovell, S. (2018, May 29). Overview and management of lower extremity chronic venous disease. In K.A. Collins (Ed.), UpToDate. Retrieved October 1, 2018, from https://www.uptodate.com/contents/overview-and-management-of-lower-extremity-chronic-venous-disease?csi=6430313b-0a6d-4266-b271-4024b76c9add&source=contentShare.
(iv) Mayo Clinic. (2017, December 28). Varicose veins: Symptoms & causes. Retrieved October 1, 2018, from https://www.mayoclinic.org/diseases-conditions/varicose-veins/symptoms-causes/syc-20350643. (v) Moneta, G. (2018, April 19). Classification of lower extremity chronic venous disorders. In K.A. Collins (Ed.), UpToDate. Retrieved October 1, 2018. https://www.uptodate.
com/contents/classification-of-lower-extremity-chronic-venous-disorders?csi=cc3253bf-f8bb-4f0e-a8f8-7a6bd7513422&source=contentShare%20. (vi) Grey, J. E., Harding, K. G., & Enoch, S. (2006). Venous and arterial leg ulcers. The BMJ, 332(7537), 347-350. doi:10.1136/bmj.332.7537.347. (vii) Center for Disease Control and Prevention. (2018, April 18). Venous thromboembolism (blood clots).
Retrieved October 1, 2018, from https://www.cdc.gov/ncbddd/dvt/facts.html.
(viii) Mayo Clinic. (2017, December 28). Varicose veins: Diagnosis & treatment. Retrieved October 1, 2018, from https://www.mayoclinic.org/diseases-conditions/varicose-veins/diagnosis-treatment/drc-20350649.