Venous Insufficiency

Your arteries carry blood from your heart to the rest of your body. Your veins carry blood back to the heart, and valves in the veins stop the blood from flowing backward. When your veins have trouble sending blood from your limbs back to the heart, it’s known as venous insufficiency. In this condition, blood doesn’t flow back properly to the heart, causing blood to pool in the veins in your legs.

Several factors can cause venous insufficiency, though it’s most commonly caused by blood clots (deep vein thrombosis) and varicose veins. Even if you have a family history of venous insufficiency, there are simple steps you can take to lower your chances of developing the condition.

Venous insufficiency is most often caused by either blood clots or varicose veins. In healthy veins, there is a continuous flow of blood from the limbs back toward the heart. Valves within the veins of the legs help prevent the backflow of blood.

The most common causes of venous insufficiency are previous cases of blood clots and varicose veins. When forward flow through the veins is obstructed — such as in the case of a blood clot — blood builds up below the clot, which can lead to venous insufficiency. In varicose veins, the valves are often missing or impaired and blood leaks back through the damaged valves. In some cases, weakness in the leg muscles that squeeze blood forward can also contribute to venous insufficiency.

Venous insufficiency is more common in women than in men. According to The University of Chicago Medical Center, it’s also more likely to occur in women between 40 and 49 and in men between 70 and 79. Other risk factors include:

• blood clots
• varicose veins
• obesity
• pregnancy
• smoking
• cancer
• muscle weakness, leg injury, or trauma
• swelling of a superficial vein (phlebitis)
• family history of venous insufficiency
• inactivity (sitting or standing for long periods of time without moving can cause high blood pressure in the leg veins and increase your risk)

Symptoms of venous insufficiency include:

• swelling of the legs or ankles (edema)
• pain that gets worse when you stand and gets better when you raise your legs
• leg cramps
• aching, throbbing, or a feeling of heaviness in your legs
• itchy legs
• weak legs
• thickening of the skin on your legs or ankles
• skin that is changing color, especially around the ankles
• leg ulcers
• varicose veins
• a feeling of tightness in your calves

Your doctor will want to do a physical examination and take a complete medical history to figure out if you have venous insufficiency. They may also order some imaging tests to pinpoint the source of the problem. These tests may include a venogram or a duplex ultrasound.

Venogram

During a venogram, your doctor will put an intravenous (IV) contrast dye into your veins. Contrast dye causes the blood vessels to appear opaque on the X-ray image, which helps the doctor see them on the image. This dye will provide your doctor with a clearer X-ray picture of your blood vessels.

Duplex ultrasound

A type of test called a duplex ultrasound may be used to test the speed and direction of blood flow in the veins. A technician will place some gel on the skin and then press a small hand-held device (transducer) against your skin. The transducer uses sound waves that bounce back to a computer and produce the images of blood flow.

Treatment will depend on many factors, including the reason for the condition and your health status and history. Other factors your doctor will consider are:

• your specific symptoms
• your age
• the severity of your condition
• how well you can tolerate medications or procedures

The most common treatment for venous insufficiency is prescription compression stockings. These special elastic stockings apply pressure at the ankle and lower leg. They help improve blood flow and can reduce leg swelling. Compression stockings come in a range of prescription strengths and different lengths. Your doctor will help you decide what the best type of compression stocking is for your treatment.

Treatment for venous insufficiency can include several different strategies:

Improving blood flow

Some tips to improve your blood flow include:

• Keep your legs elevated whenever possible.
• Wear compression stockings to apply pressure to your lower legs.
• Keep your legs uncrossed when seated.
• Exercise regularly.

Medications

There are also a number of medications that may help those suffering from this condition. These include:

• diuretics: medications that draw extra fluid from your body that is then excreted through your kidneys
• anticoagulants: medications that thin the blood
• pentoxifylline (Trental): a medication that helps improve blood flow

Surgery

Sometimes more serious cases of venous insufficiency require surgery. Your doctor may suggest one of the following surgery types:

• Surgical repair of veins or valves
• Removing (stripping) the damaged vein
• Minimally invasive endoscopic surgery: The surgeon inserts a thin tube with a camera on it to help see and tie off varicose veins.
• Vein bypass: A healthy vein is transplanted from somewhere else in your body. This procedure is generally used only when the upper thigh is affected and only for very severe cases after nothing else has worked.
• Laser surgery: This relatively new treatment uses lasers to either fade or close the damaged vein with strong surges of light in a small, specific place. It involves no surgical cuts.

Ambulatory phlebectomy

This outpatient procedure (you won’t have to spend the night in the hospital) involves your doctor numbing certain spots on your leg, and then making small pricks and removing smaller varicose veins.

Sclerotherapy

This treatment method is generally reserved for advanced venous insufficiency. In sclerotherapy, a chemical is injected into the damaged vein so that it’s no longer able to carry blood. Blood will return to the heart through other veins, and the damaged vein will eventually be absorbed by the body. Sclerotherapy is used to destroy small to medium veins. A chemical is injected into the damaged vein so that it’s no longer able to carry blood.

Catheter procedures

In severe cases, your doctor can use a catheter procedure for larger veins. They’ll insert a catheter (a thin tube) into the vein, heat the end of it, and then remove it. The heat will cause the vein to close and seal as the catheter is taken out.

If you have a family history of venous insufficiency, there are steps you can take to lessen your chances of developing the condition:

• Don’t sit or stand in one position for long stretches of time; get up and move around frequently.
• Don’t smoke, and if you do smoke, quit.
• Get regular exercise.
• Maintain a healthy body weight.