Chronic Venous Insufficiency

This title sounds as if we are talking about not having enough veins in our bodies! Actually, this topic discusses veins that do not work correctly. This term usually implies any venous disease that causes symptoms in the leg, such as swelling (edema), color changes, skin changes, or ulcerations. It normally does not include simple varicose or spider veins. The latter two are often perceived as unsightly and may or may not cause symptoms.

Veins are the vessels that return the blood from the extremities to the heart. This movement of blood is helped by the "calf pump." The calf muscle pumps the blood "upstream" to the heart when it contracts. If all of the valves are working, the blood continues to flow upwards; however, if the valves are not working correctly (incompetent), then the blood flows backwards and pools during the time the muscle relaxes. This may result in varicose veins, which are veins in which the valves do not work and blood pools at the next lowest valve. Under the pressure of gravity, they continue to enlarge, and in the course of time, they may become elongated, twisted, pouched, and thickened.

There are three locations of venous insufficiency in the leg: superficial, communicating, and deep. The superficial veins are the veins we can generally see. Communicating veins are veins which connect the superficial and deep systems like the rungs of a ladder. If the communicating veins are working properly, the blood is channeled to the deep system.

If they do not work, the blood may be forced to the surface veins when the calf muscle contracts. Deep veins are, as their name implies, deep in the leg, and are the main channel for the blood to return to the heart. If those valves do not work properly, the blood pools and can cause the symptoms of chronic venous insufficiency. Another cause of chronic venous insufficiency is blockage, such as deep-vein thrombosis (DVT) in the deep veins which prevents blood flow from returning.

Changes which occur in the leg include pain, swelling, scaly skin, skin discoloration (usually a brownish color), and ulcers (see photos). The skin becomes particularly susceptible at the ankle where the back-flow pressure is the highest.

Treatment of chronic venous insufficiency includes compression therapy such as prescription stockings, Unna's boot, four-layer wraps, single elastic bandages, or a Velcro device that prevents edema. The article on page 3 describes other treatments for superficial venous insufficiency.