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Chronic vein insufficiency

Professional Name Chronic venous insufficiency

Summary

Chronic venous insufficiency involves the failure of venal valves to close properly, so that the blood-flow, especially to the legs, is slowed down. The blood can’t properly flow “uphill”, increasing pressure inside the veins and leading to the typical symptoms.

Description

If the venous valves don’t close properly, they can’t sufficiently support the blood flow towards the heart anymore, causing a pressure increase in the affected venous segments (most commonly in the legs). Venous insufficiency can have various causes. Standing for long hours, but also sitting with the knees bent impairs the reverse blood flow, so that the valves have to stand higher pressure. A family-induced weakness of the connective tissue can further cause the venous valves not to close properly. The resulting pressure increase in the veins leads to enlarged veins (sometimes visible as varicose veins) and further symptoms, which allow the condition to be separated in three stages.

Occurrence + Symptoms

In stage one, patients suffer from swelling of the ankle and lower leg that worsens throughout the day and improves upon elevating the legs. The legs feel heavy and painful. The skin around the ankles can look dark blue (Corona phlebectatica), and the veins in this area are clearly visible. In stage two, the oedema are more or less strong, reddish-brown skin alterations appear along the lower leg, the skin becomes thin and a stasis dermatitis, a strongly itching skin inflammation caused by congestion, may occur. In stage three, all symptoms mentioned before can still be observed, and additionally the patients suffer from recurring wounds and ulcers that heal very slowly, especially above the inside of the ankle. Night cramps and a tingling sensation of the legs can occur at all stages.

Consequences + Treatment

Increasing ankle oedema and heavy, painful or even open legs lead the patient to see a doctor. Vessel sonography and an x-ray of the veins with contrast agents confirm the diagnosis; identify the affected parts and help planning the therapy. Conservative treatments include support stocking of compression class II, alternatively the legs can be wrapped with short-stretch bandages or a zinc paste bandage. Long standing and sitting should be avoided for the benefit of lying and walking. Kneipp applications (hot/cold sequence showers) support the venous blood return, as well as the activation of the muscle pump, the active ankle movement, whereby the lower leg muscles work and basically “squeeze out” the veins. If an ulcer already exists, it needs to be cleaned and the dead tissue needs to be removed, followed by a frequent and lengthy treatment with wound dressings and compressions. When the ulcer doesn’t heal or gets infected again and again, surgical measures may be considered. A surgical treatment of varicose veins can be an option as well, depending on the stage and the affected areas. Other options can be ligature of all affected veins in the groin (crossectomy), vein stripping, ligature of all connecting veins between superficial and deep venous system, sclerotherapy or laser therapy. Which therapy, if any, is recommended for each case mainly depends on the prior imaging.

Possible symptoms of the disease:

Ankle swelling, Feeling of tension in the legs, Leg swelling, Leg ulcer, Marked veins, Non-healing skin wound, Urination during the night, Leg cramps, Pain in the calves, Itching of skin, Blue colored skin, Foot swelling, Enlarged calf
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