Venous insufficiency
Chronic venous stasis; Chronic venous disease; Leg ulcer - venous insufficiency; Varicose veins - venous insufficiencyVenous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart.
Causes
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.
Veins to stay filled with blood
Varicose veins are abnormally swollen, twisted, or painful veins that are filled with blood. They most often occur in the lower legs. Below are some...
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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:
- Age
- Family history of this condition
- Female sex (related to levels of the hormone progesterone)
- History of deep vein thrombosis in the legs
Deep vein thrombosis
Deep vein thrombosis (DVT) is a condition that occurs when a blood clot forms in a vein deep inside a part of the body. DVT mainly affects the large...
Read Article Now Book Mark Article - Obesity
- Pregnancy
- Sitting or standing for long periods
- Tall height
Symptoms
Pain or other symptoms include:
- Dull aching, heaviness, or cramping in legs
- Itching and tingling
- Pain that gets worse when standing
- Pain that gets better when legs are raised
Skin changes in the legs include:
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Swelling of the legs
Swelling of the legs
Painless swelling of the feet and ankles is a common problem, especially among older people. Abnormal buildup of fluid in the ankles, feet, and legs ...
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Red or swollen, crusted, or weepy skin (stasis dermatitis)
Red or swollen, crusted, or weepy skin
Stasis dermatitis is a change in the skin that results from the pooling of blood in the veins of the lower leg. Ulcers are open sores that can resul...
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Varicose veins on the surface
Varicose veins
Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue in color. They most often appea...
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- Wound or ulcer that is slow to heal on the legs or ankles
Ulcer
Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Blood backs up in t...
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Exams and Tests
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:
Duplex ultrasound
A duplex ultrasound is a test to see how blood moves through your arteries and veins.
Read Article Now Book Mark Article- Check how blood flows in the veins
- Check for other problems with the legs, such as a blood clot
Treatment
Your provider may suggest that you take the following self-care steps to help manage venous insufficiency:
Manage venous insufficiency
Blood flows slowly from the veins in your legs back to your heart. Due to gravity, blood tends to pool in your legs, primarily when you stand. As a...
Read Article Now Book Mark Article- Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
- Care for wounds if you have any open sores or infections.
- Lose weight if you are overweight.
- Exercise regularly.
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:
- Should explain which skin care treatments can help, and which can make the problem worse
Skin care treatments
Stasis dermatitis is a change in the skin that results from the pooling of blood in the veins of the lower leg. Ulcers are open sores that can resul...
Read Article Now Book Mark Article - May recommend some medicines that may help
Your provider may recommend more invasive treatments if you have:
- Leg pain, which may make your legs feel heavy or tired
- Skin sores caused by poor blood flow in the veins that do not heal or recur
- Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
Choices of procedures include:
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Sclerotherapy -- Salt water (saline), a chemical solution, or foam is injected into the vein. The vein hardens and then disappears.
Sclerotherapy
Varicose veins are swollen, tortuous, and sometimes painful veins that have filled with blood that does not drain out in a normal fashion.
Read Article Now Book Mark Article - Phlebectomy -- Small surgical cuts (incisions) are made in the leg near the damaged vein. The vein is removed through one of the incisions.
- Procedures that can be done in a provider's office or clinic, such as using a laser, radiofrequency ablation, or a technique that uses a glue/foam to seal the vein.
Laser, radiofrequency ablation
Varicose veins are swollen, tortuous, and sometimes painful veins that have filled with blood that does not drain out in a normal fashion.
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Varicose vein stripping -- Used to remove or tie off a large vein in the leg called the superficial saphenous vein.
Varicose vein stripping
Vein stripping is surgery to remove varicose veins in the legs.
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Outlook (Prognosis)
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.
When to Contact a Medical Professional
Contact your provider if:
- You have varicose veins and they are painful.
- Your condition gets worse or does not improve with self-care, such as wearing compression stockings or avoiding standing for too long.
- You have a sudden increase in leg pain or swelling, fever, redness of the leg, or leg sores.
References
Dalsing MC, Maleti O, Westin GG. Chronic venous insufficiency: deep vein valve reconstruction. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 159.
Markovic JN, Shortell CK. Treatment of chronic venous disorders. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 157.
Pascarella L, Marston W. Venous disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 65.
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Venous insufficiency - illustration
The valves in the veins usually channel the flow of blood toward the heart. When these valves are damaged, blood leaks and pools in the legs and feet. Venous insufficiency is a condition in which the veins fail to return blood efficiently to the heart. This condition usually involves one or more veins. Symptoms include swelling of the legs and pain in the extremities such as a dull aching, heaviness, or cramping.
Venous insufficiency
illustration
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Venous insufficiency - illustration
The valves in the veins usually channel the flow of blood toward the heart. When these valves are damaged, blood leaks and pools in the legs and feet. Venous insufficiency is a condition in which the veins fail to return blood efficiently to the heart. This condition usually involves one or more veins. Symptoms include swelling of the legs and pain in the extremities such as a dull aching, heaviness, or cramping.
Venous insufficiency
illustration
Review Date: 5/10/2024
Reviewed By: Neil Grossman, MD, Saint Vincent Radiological Associates, Framingham, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.