Venous Insufficiency

Definition

Venous insufficiency occurs when veins have problems returning blood from the legs back to the heart. If a patient is predisposed to have venous insufficiency, sitting or standing for long periods of time can weaken the vein walls, damaging the vein valves that keep blood flowing in the right direction from the legs up to the heart.

Causes

Venous insufficiency is usually caused by hereditary factors (something passed down through a patient's family).

Risk

• Family history of varicose veins
• Being overweight (a Body Mass Index of 25 or higher)

Symptoms

• Ankle or leg swelling
• Tightness in the calves
• Legs feel tired, achy or heavy
• Leg pain while walking or shortly after stopping a walk
• Varicose veins (swollen veins visible through the skin)

Diagnosis

• Physical exam: The doctor may begin with an exam that includes examining varicose veins and measuring the blood pressure in the legs.
• Ultrasound: Sound waves are used to create an image of the veins and measure blood flow.
• Venogram: This procedure injects a dye to make blood flow visible on an X-ray, which measures blood flow in the veins and look for signs of clots.

Treatment

• Compression stockings: The stockings may ease the symptoms and keep blood flowing from the veins toward the heart instead of pooling in the legs.
• Sclerotherapy: A chemical solution is injected to affected veins, scarring them and preventing them from filling with blood. Blood then flows through other, healthy veins.
• Vein stripping: This procedure treats affected veins that are connected with the great saphenous vein, the largest vein close to the skin's surface along the inner thigh and calf. Through a small incision in the groin and another in the calf, the vein's branches are disconnected and the affected vein is removed. Varicose veins are then removed through several small incisions. Sometimes, a procedure called ambulatory phlebectomy is performed at the same time as the vein stripping. In this minimally invasive procedure, any varicose veins present are removed with hooks inserted through small skin incisions that don't require stitches.
• Ablation: Radiofrequency or laser energy delivered through a catheter closes off the affected vein, making it unable to carry blood.
• Bypass: For serious cases of venous insufficiency, small incisions are used to surgically connect an artificial vein or a vein transplanted from elsewhere in the body to healthy leg veins, allowing blood to flow around the damaged vein.
• Vein valve repair: A surgeon shortens the valves inside the veins to improve how they function.