Venous Insufficiency
Everything you need to know about the causes, symptoms, and most effective treatments for veins that have difficulty pumping blood from the periphery back to the heart.
Symptoms and Causes
Venous insufficiency is a disease that impairs the return of blood from the veins to the heart. Although it can occur in blood vessels of the upper and lower extremities as well as in the pelvis, it is most common in the legs.
Based on its clinical presentation, venous insufficiency is divided into two types:
- Acute venous insufficiency: occurs suddenly and usually requires urgent medical attention.
- Chronic venous insufficiency (CVI): the most common form. It develops gradually and persists over a long period of time.
The prognosis of venous insufficiency depends on the severity of the damage to the veins and the timing of treatment initiation. In most cases, patients respond adequately to therapy and only worsen if they do not receive a timely and accurate diagnosis.
Symptoms
The most characteristic symptoms of venous insufficiency are:
- Heaviness.
- Severe pain that, in acute cases, begins suddenly.
- Muscle cramps.
- Edema (swelling), often more pronounced in the afternoon.
- Changes in skin color and texture.
- Varicose veins: dilation of the veins due to increased pressure.
- Tenderness to touch.
- Venous ulcers: chronic wounds resulting from impaired venous function.
Causes
Venous insufficiency is caused by increased pressure within the veins, which may result from two different circumstances:
- Dysfunction of the venous valves, allowing peripheral blood flow to move backward rather than toward the heart.
- Venous obstruction due to a blood clot or compression by an external structure, such as an artery.
Risk Factors
The risk of venous insufficiency increases in the following situations:
- Age: valves begin to fail as tissues age.
- Sex: the effects of female hormones make women more prone to developing this disease.
- Deep vein thrombosis: valves may be damaged as a consequence of a previous thrombus.
- Obesity: pressure increases in the veins of the legs.
- Pregnancy: hormonal changes, increased pressure in the pelvic veins, and increased blood volume promote venous insufficiency.
- Prolonged standing or sitting.
- Sedentary lifestyle.
- Smoking, as it damages venous tissue.
- Genetic predisposition.
Complications
When venous insufficiency is not treated appropriately, it may lead to the following complications:
- Skin ulcers that may become infected.
- Venous thrombosis: formation of blood clots.
- Post-thrombotic syndrome: a chronic condition that develops after thrombosis, when tissues are damaged by the clot. It causes valve dysfunction and venous obstruction.
- Pulmonary embolism.
Prevention
Recommendations for preventing venous insufficiency include:
- Exercising regularly.
- Avoiding prolonged immobility whenever possible.
- Elevating the legs above heart level several times a day.
- If prolonged standing is unavoidable or there is a family history of the disease, wearing compression stockings to help the muscles pump blood.
- Maintaining a healthy body weight.
- Not smoking.
- Staying well hydrated.
- Avoiding very tight clothing and high-heeled shoes.
Which specialist treats venous insufficiency?
Venous insufficiency is a disease that is diagnosed and treated within the specialty of Angiology and Vascular surgery.
Diagnosis
The diagnosis of venous insufficiency is primarily clinical and is based on the following pillars:
- Medical history and assessment of symptoms.
- Physical examination: evaluation for the presence of varicose veins, assessment of the degree of swelling, and analysis of skin changes.
- CEAP classification: a consensus document based on Clinical manifestations (C), Etiology (E), Anatomical distribution (A), and Pathophysiology (P) to assess disease severity. During the initial evaluation, clinical manifestations are staged because they are the easiest to identify:
- C0: no visible or palpable signs.
- C1: spider veins.
- C2: varicose veins.
- C3: edema.
- C4: skin changes.
- C4a: eczema and pigmentation changes.
- C4b: skin induration and atrophie blanche.
- C4c: corona phlebectatica, i.e., intradermal veins that form around the ankle.
- C5: healed ulcer.
- C6: active ulcer.
In some cases, a Doppler ultrasound is performed to assess blood flow and rule out deep vein thrombosis.
Treatment
Treatment of venous insufficiency is individualized for each patient, taking into account disease severity and overall patient characteristics.
- Compression stockings: facilitate the return of blood from the legs to the heart.
- Sclerotherapy: a procedure in which damaged veins are eliminated. Traditionally, a saline solution was injected to harden the vessel, which subsequently disappeared. Currently, it is more common to use a foam composed of gases that are readily soluble in blood and sclerosing agents that render the vein nonfunctional.
- Medical adhesive closure: a procedure in which a specific adhesive is injected to keep the vein closed, causing blood to seek alternative pathways for circulation. It is a minimally invasive technique that requires neither anesthesia nor hospitalization.
- Thermal ablation: affected veins are eliminated through the application of heat.
