Chronic Venous Insufficiency

What is chronic venous insufficiency?

Chronic venous insufficiency is a disease caused by weak, worn, or damaged valves in the veins of the legs. It causes swelling (edema) of the legs. It can also cause sores on the legs, especially in the area of the ankles.

How does it occur?

The arteries pump blood from the heart and the veins return blood to the heart. Veins, unlike arteries, have no muscle tissue. Veins require the muscles in our feet and legs to return the blood, against gravity, to the heart. To help this process, the veins have a series of valves in them that prevent back flow.

The valves in your veins may be weak or worn. When these valves are not working well, the blood has difficulty moving upward. Prolonged increased pressure in the veins causes the valves to stretch out, making them unable to close properly. As a result, the blood flows back into other veins and pools in the tissues of the legs, causing swelling. It can also cause small veins in the skin to break. These sores are called stasis or varicose ulcers. The ulcers increase your risk of injury and infection. They are often difficult to treat.

Obesity, inactivity, and aging can contribute to the weakening of or damage to the valves. Valve damage can also occur if you have had a blood clot in your leg. Some people may have just inherited weak valves.

Chronic venous insufficiency is different from the problem of varicose veins. Varicose veins are enlarged, sometimes painful veins in the legs, but they usually don't have the fluid leakage that leads to chronic venous insufficiency. Sometimes, however, people with chronic venous insufficiency have varicose veins.

What are the symptoms?

Symptoms may include:

• swelling
• changes in the color of your skin, usually in the area of your ankle
• pain
• rash
• enlargement of the veins close to the surface of your skin
• skin ulcers, usually on or near the ankle.

When you have stasis ulcers in the skin, the blood in the tissue breaks down and leaves a brownish color. The skin becomes dry, cracks, and itches.

How is it treated?

The goals of treatment are to reduce the pooling of blood and prevent ulcers. Activities that increase venous blood flow, reduce pooling, and help prevent ulcers are:

• elevation of the legs to allow pooled blood to drain
• compression of veins close to the skin to prevent pooling.

To allow pooled blood to drain, elevate your legs by raising them above the level of your heart at set times throughout the day. Keep your legs raised for at least 30 minutes every 2 hours. At night, sleep with your feet raised about 6 inches by propping them on pillows.

Special stockings may be prescribed by your health care provider to compress your legs and help the blood to return to the heart. Proper fit is very important. The stockings must provide greater pressure at the foot and ankle and gradually declining pressure up the leg. You should put the stockings on after a period of leg elevation, for example, before you get out of bed in the morning.

How can I take care of myself?

• Keep your legs raised above the level of your heart for at least 30 minutes every 2 hours. Sleep with your legs propped on pillows.
• Avoid long periods of sitting or standing. Walking is better for blood flow.
• When you are sitting, avoid crossing your legs or dangling them over the edge of a chair or bed.
• Avoid wearing girdles, leg garters, and other tight-fitting garments.
• Maintain a healthy weight. If you are overweight, try to lose some weight.
• Protect your feet and legs from injury.
• Keep your skin clean, dry, and soft. Wash with a mild soap, dry carefully, and apply an unscented lotion right away if dryness has been a problem.
• Call your health care provider's office right away if you see signs of sores developing.

How can I help prevent chronic venous insufficiency?

A walking program that starts with only a few steps every day but builds slowly and steadily may help prevent the problem from getting worse.