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Venous Insufficiency

Venous Insufficiency

Definition

Venous insufficiency is described as abnormal blood flow through veins that can cause local damage, damage to affected legs, or death.

Description

Syndromes related to venous insufficiency are caused by valve incompetence. Venous insufficiency is a chronic (long term) condition. The number of new and existing cases is dependent on age and gender. Some patients may have a positive family history. Usually older persons and females are more commonly affected. Deep situated and superficial veins can be affected. Cancer obstructing veins in the pelvis area can cause superficial venous insufficiency. Deep venous insufficiency is commonly caused by thrombophlebitis, causing obstruction of valves that regulate blood flow in veins. Small veins that have been occluded by a thrombosis may re-canalize (opening up new channels to re-direct blood flow). These re-canalized veins are inadequate and cannot correct the impairment of flow. However, larger veins may still remain occluded. When a thrombosis occurs the valves that regulate venous blood flow become thickened and incompetent, rendering them incapable of regulating back flow of blood. This valvular incompetence will cause an increase in the presence within veins (venous hypertension ). Venous hypertension is responsible for most of the symptoms associated with venous disease. Superficial veins can become dilated causing varicose veins (veins that bulge and seem tortuous). Leg ulcers can be severe and are responsible for 100,000 cases of disability in the United States alone.

Causes and symptoms

The symptoms of chronic venous insufficiency can be subjective and objective. Subjective symptoms include throbbing, cramping, burning sensations, and leg fatigue. Patients can also develop chronic leg ulcers that may not heal. Varicose veins in the legs can bleed (since veins are delicate structures with thin walls) and cause death. Patients often develop fluid retention (edema ) in the affected limb. Skin changes can occur and affected areas can become thin, shiny, discolored (blue-purple), and atrophic. The skin usually becomes thick and tough.

Diagnosis

There are several techniques used to diagnose venous disease. Electrical impedance plethysmography (IPG) provides a functional evaluation for outflow obstruction ultrasound (a machine that transmits sound waves) studies can visualize the venous system in certain areas. Another technique called duplex scanning can measure velocity within a vein.

Treatment

Periodic elevation of legs and bed rest can help with leg swelling. Patients are advised to avoid prolonged periods of standing or sitting. Wearing compression stockings can also reduce swelling of the leg. Mild skin infections can be treated with compresses, steroids, and, if infection is present, with antibiotics. Ulcerations can be treated with compresses, possible surgery, special ointments, and a semi-rigid boot that helps improve blood flow. Varicose veins can be treated with elastic stockings. About 15-20% of patients require surgery, but only after careful evaluation and specialized testing confirms a beneficial value.

Prognosis

The prognosis is variable and depends on the progression of disease, extent of damage, and the presence of other diseases, which may affect the cardiovascular system.

Prevention

Persons who have a strong family history, evidence of disease, and/or those who stand on their legs many hours daily should discuss the option of elastic stocking with their primary clinician.

Resources

BOOKS

Goroll, Alan H., et al. Primary Care Medicine. 4th ed. Lippincott, Williams & Wilkins, 2000.

Townsend, Courtney M. Sabiston Textbook of Surgery. 16th ed. W. B. Saunders Company, 2001.

KEY TERMS

Atrophic A wasting of cells and tissues.

Thrombophlebitis Venous inflammation with formation of a thrombus.

Thrombus A clot in the cardiovascular system (the system that circulates blood throughout the body).

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