Venous Insufficiency 101

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Venous Insufficiency 101

As the name implies, venous insufficiency is a condition characterized by veins that do not work as well as they should. Of course, the job of veins is to return oxygen- and nutrient-depleted blood from the body’s organs and tissues back to the heart and lungs, for immediate re-oxygenation and recirculation.

Venous insufficiency commonly affects the veins in the lower extremities. Problems arise in the legs and feet primarily because of the mechanical challenge of moving blood upwards, against the pull of gravity. Veins contain valves to help prevent the back flow of blood. In some instances, problems arise when these valves become dysfunctional.

This is often the case when varicose veins are involved. Venous insufficiency typically arises due to blood clots, which block blood flow, or following the development of varicose veins. When leg veins struggle to return blood to the heart, blood can begin to pool in the legs, causing swelling and discomfort. Venous insufficiency is sometimes referred to as chronic venous insufficiency, because the dysfunction is not readily reversible. Rather, it is often progressive in nature. Estimates vary, but up to 40% of adults may suffer from some form of this condition.

Risk Factors

Venous insufficiency was once believed to affect women more often than men, but recent research suggests that men may actually be affected slightly more often than women. Much of what we know about chronic venous insufficiency comes from long-term studies conducted on men and women in Edinburgh, Scotland. Nearly one thousand randomly chosen subjects were followed for close to a decade and a half, to determine the extent, nature, risk factors, and progression of any venous disease in subjects’ legs.

Advancing age and excess body weight appear to be among the chief risk factors associated with the condition, regardless of sex. While these are the two factors most commonly linked to chronic venous insufficiency, various other risk factors have been identified that may affect one’s likelihood of developing the condition. They include obesity, blood clots, family history of venous insufficiency, varicose veins, frequent constipation, a history of deep vein thrombosis, pregnancy, smoking, and prolonged sitting. A large study conducted in Poland concluded that obesity and inactivity are especially important risk factors among women.

As this list of risk factors suggests, avoiding smoking and obesity, and engaging in regular physical activity, can go a long way toward reducing one’s risk of being affected by venous insufficiency. That’s because leg veins depend on assistance from leg muscles to do their work. Sitting too much renders leg muscles inactive, so they cannot readily provide the muscular contractions that help the veins do their job and keep blood moving toward the heart.

Recent research suggests that even people already diagnosed with chronic venous insufficiency can benefit significantly from leg exercises. In one study, participants performed “isokinetic exercises for the calf muscles”. Subjects who exercised for up to three months experienced significant reductions in pain and discomfort, improvements in blood flow, and improved venous function and range of motion. Other studies have reached similar conclusions.    

Signs and Symptoms

Most people discover they are suffering from venous insufficiency after experiencing one or more of the following symptoms, which may affect the legs, ankles, and/or feet: swelling (edema), leg cramps, pain in the legs upon standing, itching, weakness, thickening or discoloration of the skin, aching (or a sensation of heaviness), varicose veins, spider veins, and leg ulcers.

Treatment

Treatment for chronic venous insufficiency, as noted above, may include prescribed exercise to improve calf muscle strength. Weight loss is also indicated to relieve pressure on over-taxed veins. Switching to a more healthful diet, featuring whole foods such as vegetables, fruits, whole grains, fresh herbs, fish, nuts, extra virgin olive oil, and legumes, can also help by reducing inflammation in the body, and encouraging weight loss.

Compression wear, which features graduated, medical-grade compression—which squeezes the legs more at the bottom, and gradually less toward the top—can help encourage the return of blood from the legs toward the heart. Prevention of complications from advanced disease is paramount. Complications such as leg ulcers are potentially serious. Patients and their doctor(s) should work toward a solution that help avoid them.

As is so often the case, this condition is more treatable in its earlier stages. Prescriptions typically include more walking, less sitting, elevating the legs during rest, losing weight, avoiding prolonged sitting (when traveling, it’s crucial to flex and extend the legs every few minutes, if possible), wearing medical-grade compression hosiery or garments (as directed by your physician or healthcare provider), paying special attention to skin care to avoid drying and cracking, and taking prescribed antibiotics to avoid infection if ulcers develop.

Some doctors may prescribe a medication to improve blood flow. When combined with diligently worn compression stockings, this combination can be very effective. Patients who have previously suffered from blood clots in the legs (post-thrombotic syndrome) may be prescribed a blood thinner medication to help prevent the recurrence of potentially dangerous clots.

Most experts caution that attention to skin care is important, in order to preserve the integrity of the skin surrounding affected areas. Due to interruptions in optimal blood flow, skin may become fragile and susceptible to flaking or cracking. This, in turn, can provide a route for infection. Applying skin moisturizers regularly is considered a fundamental aspect of proper care.      


References

Baliyan V, Tajmir S, Hedgire SS, Ganguli S, Prabhakar AM. Lower extremity venous reflux. Cardiovascular Diagnosis and Therapy. 2016;6(6):533-543. doi:10.21037/cdt.2016.11.14.

Cleveland Clinic website. Chronic Venous Insufficiency (CVI): Treatment Options page. Accessed Sept. 29, 2017 from: https://my.clevelandclinic.org/health/articles/chronic-venous-insufficiency/treatment-options.

Ercan S, Çetin C, Yavuz T, Demir HM, Atalay YB. Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency. Phlebology. 2017 Jan 1:268355517695401. doi: 10.1177/0268355517695401. [Epub ahead of print]

Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. Journal of Epidemiology and Community Health. 1999;53(3):149-153.

Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology. 2003 Jul-Aug;54 Suppl 1:S19-31.

Padberg FT Jr, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. 2004 Jan;39(1):79-87.

Robertson L, Lee AJ, et al. Incidence of chronic venous disease in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord. 2013 Jan;1(1):59-67. doi: 10.1016/j.jvsv.2012.05.006. Epub 2012 Dec 8.

Robertson LA, Evans CJ, et al. Incidence and risk factors for venous reflux in the general population: Edinburgh Vein Study. Eur J Vasc Endovasc Surg. 2014 Aug;48(2):208-14. doi: 10.1016/j.ejvs.2014.05.017. Epub 2014 Jun 18.

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  1. JOBST Compression Institute (JCI) is a great resource for clinicians, fitters and care providers who want to learn more about chronic venous diseases and lymphedema.

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