Vein conditionsChronic Venous Insufficiency

What is Chronic Venous Insufficiency?

Venous insufficiency, also called venous reflux, is a condition that develops in your legs when blood pools in the legs due to abnormal leg vein valve function.

 

What causes Chronic Venous Insufficiency?

Your legs have a network of veins. These veins have dozens of one-way valves that help blood return back to the heart. Venous reflux disease (venous insufficiency) develops when one or more of these valves fail (i.e. leak), causing blood to flow backward in the leg veins. This results in blood pooling in the legs. The abnormal blood pooling is under increased venous pressure (hydrostatic pressure), which results in different symptoms, vein conditions and skin changes.

Diagram Valves (Normal vs Dilated Veins)

What are the risk factors for venous insufficiency?

Risk factors for chronic venous insufficiency (venous reflux) are:

Family history. This is the most significant risk factor. If you have one parent with vein problems, you have a 50% chance of having a vein problem yourself. The chance increases to 80% if you have two parents with vein disease. The genetic risk factor can skip a generation, so your parents might not have a vein problem, but a grandparent might.

Female gender. Woman are three times as likely to get venous insufficiency as men. This is because of the female hormone progesterone. Progesterone causes veins to dilate and vein valves to weaken, causing them to leak and letting venous blood flow reverse.

Pregnancy. There are several physiological factors that put women that have had full term pregnancies at increased risk for developing venous insufficiency, varicose veins and spider veins. First, there are increased levels of progesterone in the blood during pregnancy, and progesterone causes vein to dilate and the valves to weaken, causing them to leak. Second, pregnant women can have a 50% increase in blood volume. Blood is naturally sored in veins in the legs. The increased blood can cause veins to dilate, leading to venous insufficiency. Third, as the uterus enlarges, it can put pressure on the veins in the pelvis, causing blood to back up in the legs. Many times, once the pregnancy is over, the veins return to normal. Sometimes, especially after two or more full term pregnancies, the veins can remain abnormal and may need treatment. Vulvar varices can also be caused by pregnancy.

Prolonged standing or sitting. Extended periods of time standing in place or sitting can cause the valve in leg veins to reflux. This is due to the hydrostatic pressure from gravity. Also, when in one is stationary, the calf muscles are not pumping blood which can lead to blood pooling.

Age. The older we get, the more time gravity has to work against the valves, causing them to weaken and leak. For example, 40% of women over 40 years old have some degree of venous insufficiency, while the number jumps to 60% for women over 60 years old.

Obesity. This is a mild risk factor. Increased pelvic pressure due to abdominal fat can put pressure on the leg veins, causing higher venous pressure in the legs.

What are symptoms of Chronic Venous Insufficiency?

  • Achy, painful legs
  • Tired, heavy, fatigued legs
  • Swelling of ankles and legs
  • Bulging veins (varicose veins)
  • Itching, irritation, dryness, tingling or burning sensation of the skin
  • Skin discoloration, redness or inflammation
  • Ulcer or non-healing wounds on the lower legs
  • Spider veins

How is Chronic Venous Insufficiency diagnosed?

Venous insufficiency, also called venous reflux, is diagnosed with a special type of ultrasound examination called venous duplex ultrasound. This is a non-invasive test done in the office that checks the function of the leg vein valves, the diameter of the veins, the presence or absence of blood clots and any other venous abnormalities. A history and physical examination of the legs are also part of the diagnosis process.

What are the treatment options for Chronic Venous Insufficiency?

The goal of treatment of chronic venous insufficiency is to stop the backward blood flow in the veins, stop the blood from pooling, and reduce the venous pressure in the legs. There are several options for treating venous reflux:

Compression stockings. Medical grade graduated compression stockings, usually 20-30 mmHg in strength. The external compression counteracts the increased pressure and dilation of the veins, and helps the calf muscles pump blood better.

Ablation of the abnormal veins. Definitive treatment of venous insufficiency involves closing down the veins that have venous reflux. This is an office based procedure that is done using local anesthesia with little or no down time.

Other treatment options. See Treatment Options for a complete list and explanation of all the treatment modalities.

Chronic Venous Insufficiency can be treated using the following treatments:

Radiofrequency Ablation (RFA)
Micro-Phlebectomy
Color Duplex Venous Ultrasound Exam
Combined Therapy and Treatment Plan
Compression Stockings
Endovenous Laser Ablation (EVLA)
Surface Laser Treatment
Sclerotherapy (Liquid, Foam)
Ultrasound Guided Foam Sclerotherapy

Educational Videos

  • View the vein condition, chronic venous insufficiency, treated at VEINatlanta located in Atlanta, Georgia.

  • View the risk factors of chronic venous insufficiency.

  • Dr. Prevosti, of VEINatlanta, addresses the question, “What are the symptoms of venous reflux?”.

  • Dr. Prevosti, of VEINatlanta, addresses the question, “Can you prevent venous reflux?”.