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Chronic Venous Insufficiency

Definition

Chronic venous insufficiency is a problem with how your veins are working. Veins collect blood from the body to bring back to the heart. The veins have one-way valves throughout the blood vessel that keep the blood moving in the right direction, toward the heart. When these valves do not close properly, blood can leak backwards. This can cause a back up of blood in the veins especially areas of the body where veins must work against gravity like the legs.
Venous Insufficiency
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Causes

Chronic venous insufficiency is caused by higher than normal pressure in the veins and damage to the valves that keep blood flowing toward the heart. It can be caused by blood clots or swelling and inflammation of the veins. Blood clots in the legs can damage the valves in the veins. When people get chronic venous insufficiency after a blood clot, it may be referred to as post-thrombotic syndrome. When it occurs after phlebitis, it may be referred to as post-phlebitic syndrome.
Causes of chronic venous insufficiency include:

Risk Factors

Chronic venous insufficiency is more common in women and in people aged 50 years and older. Other factors that may increase your chance of getting chronic venous insufficiency include:

Symptoms

Chronic venous insufficiency may cause:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Images may be taken of your bodily structures. This can be done with:

Treatment

Treatment is aimed at maintaining blood flow and preventing it from pooling. Treatment involves the following:

Improving Blood Flow

Special elastic stockings that squeeze the veins in the legs may be advised. They will help keep the blood from pooling. You may also be advised to raise your feet and legs above the level of your heart while resting or sleeping. You may need to do this several times a day.
Therapeutic massage of the lower legs may be advised to reduce discomfort and to drain fluid build up.

Movement

Walking and specific exercises for your legs and feet may help. Long periods of sitting and standing should be avoided.

Skin Care

Mineral bath therapy may help to improve skin redness. Bandages or antibiotic cream may be advised to help prevent skin infection. Wearing compression stockings may also promote healing.

Sclerotherapy or Ablation

Sclerotherapy may be advised. It involves injecting a caustic material into the affected veins. Scar tissue fills the veins. The blood is rerouted through functioning veins. Ablation is another procedure used to treat the veins. A tiny electrode is inserted into the affected vein. Electricity scars the vein and blocks it off.
With both treatments, your body will resorb the non-functional vein over time.

Surgery

Surgery is reserved for the few cases that do not respond to conservative treatment. The type of surgery will depend on the cause of the condition and the results of testing. Some possibilities include:
  • Valve repair
  • Vein stripping to remove the faulty vein.
  • Bypass surgery—A new length of artificial vein is connected to 2 areas of the malfunctioning vein. This allows the blood flow to bypass the area that is not working.

Prevention

To help reduce your chance of developing chronic venous insufficiency, take these steps:

RESOURCES

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

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

CANADIAN RESOURCES

Canadian Society for Vascular Surgery http://canadianvascular.ca

Health Canada http://www.hc-sc.gc.ca

References

Chronic venous insufficiency. Vascular Web website. Available at: http://www.vascularweb.org/vascularhealth/Pages/chronic-venous-insufficiency.aspx. Updated January 2011. Accessed June 29, 2015.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: O'Meara S, Cullum N, Nelson E. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2009;(1):CD000265.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Carpentier PH, Satger B. Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency. J Vasc Surg. 2009;49:163-170.

3/30/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed. dos Santos Crisóstomo RS, Costo DS, et al. Influence of manual lymphatic drainage on health-related quality of life and symptoms of chronic venous insufficiency: a randomized controlled trial. Arch Phys Med Rehabil. 2015 Feb;96(2):283-291.

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