Chronic venous stasis; Chronic venous disease; Leg ulcer - venous insufficiency; Varicose veins - venous insufficiency
Venous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart.
Normally, valves in your deeper leg veins keep blood moving forward toward the heart. With long-term (chronic) venous insufficiency, vein walls are weakened and valves are damaged. This causes the veins to stay filled with blood, especially when you are standing.
Chronic venous insufficiency is a long-term condition. It is most commonly due to malfunctioning (incompetent) valves in the veins. It may also occur as the result of a past blood clot in the legs.
Risk factors for venous insufficiency include:
If you have dull, aching, or cramping pain in your legs, and pain that gets worse when you stand, you may have a condition called venous insufficiency.In venous insufficiency, the veins in your legs have trouble sending blood back to your heart. Normally, valves in your legs keep your blood flowing back towards your heart so it doesn’t collect in one place. But the valves in varicose veins are either damaged or missing. This causes your veins to remain filled with blood, especially when you’re standing. A blockage in your vein from a blood clot, called a deep venous thrombosis, can also cause this problem. So, how do you know if you have venous insufficiency?Well, you’ll probably feel a dull aching, heaviness, or cramping in your legs. Your legs will swell up when you’re on them too long. Your legs may itch or tingle. Pain will get worse when you stand, and better when you raise your legs. Your legs and ankles may also be red. You may notice skin color changes around your ankles. You may see varicose veins on the surface of your legs. You may feel thickening and hardening of the skin on your legs and ankles.So, what can you do about venous insufficiency?Well, your doctor will tell you to use compression stockings to decrease the swelling in your legs. You’ll probably have to avoid long periods of sitting or standing. Even moving your legs slightly will help the blood in your veins return to your heart. Walking helps in that same way. Your doctor may recommend surgery or other treatments for varicose veins if you’ve tried everything and you still have leg pain that feels heavy or tired, skin ulcers or sores caused by poor blood flow.If blood clots are causing you problems, your doctor may prescribe anticoagulant or blood-thinning medicines, to treat existing blood clots and prevent others.Your doctor may suggest you try to keep your legs elevated above your heart when you lie down. You may improve your circulation through exercise. And finally, if you need to lose weight, weight loss can be a very helpful treatment of venous insufficiency and swelling.
Pain or other symptoms include:
Your health care provider will do a physical exam and ask about your symptoms and medical history. Diagnosis is often made based on the appearance of leg veins when you are standing or sitting with your legs dangling.
A duplex ultrasound exam of your leg may be ordered to:
Your provider may suggest that you take the following self-care steps to help manage venous insufficiency:
You can wear compression stockings to improve blood flow in your legs. Compression stockings gently squeeze your legs to move blood up your legs. This helps prevent leg swelling and, to a lesser extent, blood clots.
When more advanced skin changes are present, your provider:
Your provider may recommend more invasive treatments if you have:
Choices of procedures include:
Chronic venous insufficiency tends to get worse over time. However, it can be managed if treatment is started in the early stages. By taking self-care steps, you may be able to ease the discomfort and prevent the condition from getting worse. It is likely that you will need medical procedures to treat the condition.
Call your provider if:
Freischlag JA, Heller JA. Venous disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier Saunders; 2017:chap 64.
Raffetto JD, Eberhardt RT. Chronic venous disorders. In: Cronenwett JL, Johnston KW, eds. Rutherford's Vascular Surgery. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55.
Last reviewed on: 6/6/2016
Reviewed by: Deepak Sudheendra, MD, RPVI, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.