Overview

Venous Insufficiency (VI) is a condition that affects veins of the body, especially those in the arms and generally – the legs. In this condition, blood starts accumulating in the lower legs, leading to various symptoms and health-risks. The condition is generally chronic and is often called Chronic Venous Insufficiency (CVI). For the purpose of this article, VI and CVI are treated as the same.

Introduction

Arteries carry pure blood (rich in oxygen) from the heart to various parts of the body, while veins carry impure blood (devoid of oxygen) from those parts back to the heart. There are tiny valves with 2 flaps each (Biscuspid valves) present in veins that ensure unidirectional blood-flow, from rest of the body to the heart.

In some people, the valves in the veins, especially those in the legs, fail to work properly. As a result, impure blood does not travel up to the heart, and starts backing down instead. The impure blood then starts accumulating or pooling in the lower legs (called ‘stasis’) leading to various symptoms and health-risks. This condition is called Venous Insufficiency.

VI progresses in stages, and after stage 3, it is said to be chronic. Most cases of VI detected are that of Chronic Venous Insufficiency or CVI. CVI is a lot more common than previously known. Worldwide, it is said to affect 1 in 20 people who have one or more risk factors.

Causes

Causes for CVI are classified as:

1. Congenital: The condition is present since birth. Valves in the veins are either missing or not formed properly leading to CVI eventually.
2. Primary: Certain changes in the legs lead to valve malfunction. For example, the veins may get too wide leading to flaps of the valves not able to close properly.
3. Secondary: There are various health and lifestyle-related conditions which can trigger CVI after some time. Deep Vein Thrombosis (DVT) is the most common of these.

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Also Read: Varicose Veins – Causes And Treatment

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Risk Factors

• Blood clots in veins that are deep inside the leg, especially the calf or thigh (deep vein thrombosis or DVT): A clot can block the vein, thereby preventing the blood from reaching the heart.
• Had damage to your leg due to injury, surgery, or previous blood clots: reasons as above
• A history of DVT
• Are overweight: This causes high blood-pressure in veins of the lower legs leading to CVI
• Are pregnant: reasons as above
• A family history of CVI
• Sitting or standing for long periods of time leading to high blood-pressure in veins of the legs.
• Sedentary lifestyle: Muscles in the leg, especially the calf muscles act like a pump and push the blood up to the heart. Lack of exercise weakens these muscles, eventually triggering CVI.
• Smoking: Toxins in tobacco can damage small nerves, causing the valves to fail eventually.
• Swelling and inflammation of a vein that is close to the skin (superficial pain), especially in the legs (condition called as phlebitis)
• Varicose veins or a family history of varicose veins.
• Sleeping in a chair or recliner: an awkward position of the leg can increase blood-pressure in it, increasing the risk for CVI
• May-Thurner syndrome: In this, the right iliac artery, which carries pure blood from the heart to the right leg, presses on the left iliac vein which brings impure blood from the left leg to the heart. This causes DVT and blood-clots in the legs.
• Being female
• Being over 50 years of age
• Cancer
• Muscle weakness due to leg injury, trauma, sedentary lifestyle or other reasons
• Swelling of a superficial vein (phlebitis)

Symptoms

• Varicose veins, also called Spider veins: these are twisted and enlarged, knotted veins close to the surface of the skin, seen in the lower legs.
• Edema or swelling in the lower legs, including the ankles
• Tightness in the calves
• Itchy and flaky skin in the legs and ankle
• Painful legs, aching or tired legs, throbbing or heavy feeling in the legs
• Pain while walking and standing that goes when the person is sitting down, or puts the legs up
• Discolouration of the skin: brown-coloured skin, generally close to the ankles
• Ulcers or open sores, generally near the ankles and which are not easy to treat. If they’re very painful, they could be infected
• Symptoms of Restless Legs Syndrome or RLS: This includes pain or discomfort in the legs and an uncontrollable urge to move the legs
• Muscle spasms and cramps, both in the legs which are painful (also called charley horse)
• Burning or tingling sensation (“pins and needles”) in the legs
• Leg cramps that get worse at night
• Leathery-looking skin on your legs
• Weak legs
• Thick or hard skin in the legs or ankles
• Open sores on the skin of the legs
• Blood clots in the legs

Diagnosis

• Physical examination: The doctor will examine the patient’s legs thoroughly for signs of discolouration, ulcers, DVT, varicose veins etc. Since patients of CVI also have Peripheral Arterial Disease (PAD) in many cases, the doctor will look for signs of PAD too.
• Venogram: This is basically an X-ray of the veins. In this procedure, the doctor will first insert a contrast dye into the patient’s veins using a catheter. While normally, the veins would appear opaque on X-ray image, adding the contrast dye helps show the blood-flow in the veins. This will give a clear X-ray picture of the patient’s blood vessels.
• Duplex ultrasound: This is an ultrasound test that will reveal both the speed and direction of blood-flow in the veins. First, a lab technician will apply some gel on the skin. After that, a small device which is a transducer is placed at that spot on the skin. The device produces sound waves which are bounced back by the veins. The bounced or reflected waves are captured by a computer that will produce images of blood-flow.

Treatment

Home Remedies

• These remedies help increase blood-flow in veins of the leg. They include:
• Wearing compression stockings: These are worn like socks and made of rigid material. This applies pressure on the legs and increases blood-flow. The material used in the stockings is such that it also helps in healing ulcers.
• Elevating or keeping the legs up while sitting or sleeping: This reduces blood-pressure in the leg veins and promotes unidirectional flow of blood.
• Exercise: Walking and light running help the body pump blood better and increase strength in the leg muscles. This in turn improves blood-flow.
• Uncrossing the legs when sitting, or keeping the legs parallel.
• Constant movement: Whether at work or at home, the patient must avoid sitting or standing for long. Every 30 minutes, he/she must get up, walk around, stretch the legs, and wiggle the feet and ankles. All these relieve blood-pressure in the legs and promotes smooth blood-flow.

Medication

Specific drugs are given to improve blood-flow. Combined with compression therapy, they help heal leg ulcers. They include:

• Blood-thinners: Also called anti-coagulants, they help treat recurring problems with leg veins.
• Aspirin: This is prescribed to help heal leg ulcers.
• Antibiotics: Again, this helps treat leg ulcers.
• Pentoxifylline: This helps improve blood-flow, and combined with compression therapy, it helps heal leg ulcers.

Minimally Invasive Procedures

• Ambulatory phlebectomy: This is an outpatient procedure that helps remove small varicose veins.
• Laser therapy: This helps to collapse and seal veins that are damaged.
• Sclerotherapy: In this, a chemical is injected into the damaged vein, because of which, it can no longer carry blood. So now, the blood returns to the heart through clean veins.
• Subfascial Endoscopic Perforator Surgery (SEPS): In this, an endoscope is inserted into the damaged vein. Using tools carried at the end of the endoscope, the damaged vein is clipped off and tied. The blood-flow in this vein is permanently blocked, so now blood returns to the heart though healthy veins. The procedure also helps heal ulcers.
• Endovenous thermal ablation: Here, high-frequency radio waves, or a laser is used, to heat and close the problem vein.
• Catheter procedures: A catheter is inserted into the damaged vein, and heat treatment given. This helps close and seal the vein, as and when the catheter is removed.

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Also Read: Veins – Frequently Asked Questions

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Surgery

This is used in severe cases of CVI (less than 10 percent of CVI cases).

• Angioplasty and stenting: The obstruction in the vein is removed and the vein widened. This is generally used when veins deep inside the leg are affected.
• Ligation: In this, the damaged vein is tied, to stop blood-flow in it. In case the vein or valves in it are badly damaged, the vein itself is removed (“vein stripping”).
• Surgical repair: Using open, incisional surgery or a catheter, the damaged valves or vein can be repaired surgically.
• Vein bypass: When all else fails, a healthy vein from another part of the body is used to bypass the blood-flow around the damaged vein. This procedure will require hospitalization of 2-5 days.
• Vein transplant: Here, a healthy vein taken from another part of the body is grafted onto the affected vein after removing the damaged section.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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