Chronic Venous Insufficiency

What is it?

Chronic venous insufficiency is a condition in which the blood, which normally would flow back to the heart from the veins in the legs, does not do so efficiently, because the valves in the veins are damaged or absent.

As a result, blood pools in the legs, and causes complications without treatment. Conditions which may result are pain and swelling of the legs, skin infections or skin ulcers.

Causes

• Congenital absence , weakness or damage to the valves of the leg veins, (both of the superficial veins and the perforating veins)
• The condition may also be caused by a deep vein thrombosis (DVT). This may be referred to as the “post-thrombotic syndrome” or “post-phlebitic syndrome”.
• Increased venous pressure in the legs
• Rarely, varicose veins.

Risk factors

• Increased age
• Other family members with the condition
• Lifestyle – that includes obesity, sedentary lifestyle or jobs (involving sitting or standing for long periods of time), smoking, wearing tight or restrictive clothing which impair the venous circulation.

Symptoms

• Pain in the legs, worse on standing and improved by elevating the legs
• Swelling of the legs
• Dull, aching, itching, cramping feeling, due to venous hypertension

Signs can include:

• Swelling (oedema) of the leg/s
• Varicose veins
• Non-healing ulcers on the leg/s, especially on the insides of the ankles (this is where the pressure in the veins is greatest)
• Characteristic skin changes which include scaly skin, hard and pigmented skin on the legs. The pigment is a reddish brown due to a leakage of red blood cells into the skin.
• “Champagne Bottle Leg” which describes the calf of the leg becoming permanently enlarged, with a narrow ankle. This is as a result of the leakage of plasma into the subcutaneous (fatty) tissue, which causes fibrosis of this tissue layer. This is known as lipodermatosclerosis.

Investigations

• Venous Ultrasound Doppler to assess the state of the veins and the blood flow, also the presence of any clot.
• Venogram (a dye is injected into the veins which allows visualization of the veins).

Treatment

• Leg elevation - “Toes above the nose”
• Elastic support stockings - the pressure being greatest at the ankle, and progressively decreasing the higher up the leg
• Mobilisation – walking and exercising the legs and feet
• Treat venous ulcers
• Treat varicose veins

Amended April 2008