In medicine, the term chronic venous insufficiency refers to a venous disease in which a so-called congestion syndrome occurs in the veins. It occurs particularly frequently in the legs and leads to water retention and skin changes. The disease can be treated in various ways, which can lead to significant relief of symptoms.
What is chronic venous insufficiency?
Chronic venous insufficiency is a disease mostly of the leg veins, affecting both superficial and deep veins. The function of the affected veins is initially slightly impaired by the insufficiency and then severely impaired as it progresses. It is not uncommon for chronic venous insufficiency to be based on previous thrombosis. Since it is a chronic condition, the disease is permanent and cannot be cured. However, it can be alleviated with appropriate therapy and certain behavioral rules. According to statistics, up to 10% of all adult Germans are affected by chronic venous insufficiency, with women suffering more frequently.
Causes
The causes of chronic venous insufficiency are only rarely due to congenital venous weakness. In most cases, it is personal risk factors and individual lifestyle that contribute to the occurrence of the disease. If there is an increased incidence of chronic venous insufficiency in the family, the likelihood of developing the disease is higher than without this pre-existing condition. People who are largely sedentary and get little exercise even in their free time are particularly at risk. Being overweight, wearing shoes that are too tight, smoking, or, in women, taking hormonal contraceptives (“the pill”) can also contribute to the possibility of developing chronic venous insufficiency with advancing age.
Symptoms, complaints, and signs
Since the blood can no longer flow out of the leg veins as usual in chronic venous insufficiency, the pressure in the leg veins increases and there is a feeling of heaviness or tension. In most cases, a dull aching pain also occurs. These symptoms are particularly intensified by long periods of walking and standing. Based on other symptoms, chronic venous insufficiency is divided into three stages. In the first stage, there is reversible edema, i.e. fluid accumulation in the lower legs, which disappears when the legs are elevated. In addition, the dilated veins become visible, especially in the area of the ankles, in the form of so-called popliteal veins. Dark blue skin vein changes can be observed above the edges of the feet. In stage 2, the edema does not regress and the legs are permanently swollen. Red-brown skin discoloration in the area of the lower legs and white patches mostly above the ankles are seen. In addition, so-called stasis eczema, an itchy skin rash, can form in the affected areas. Doctors speak of stage 3 when the skin dies off, the so-called necrosis. This defect usually extends into deep layers of the skin and is very difficult to heal. The now open leg is called ulcus cruris.
Diagnosis and course
Often, chronic venous insufficiency can be detected by the treating physician already existing skin changes on the lower leg and foot. In addition to a detailed discussion, the legs are palpated and examined with an ultrasound device. With the help of photoplethysmography, the venous pressure is determined. In this way, it can be determined exactly whether, at which point and how far the veins are narrowed. In addition, a prognosis can be made as to whether and how the disease can be treated. The course of chronic venous insufficiency depends on the individual case. In most cases, if left untreated, swelling and subsequent skin and tissue changes occur. In the worst case, a so-called open leg can develop, which is painful and difficult to treat.
Complications
Chronic venous insufficiency can lead to various complications, some of them very serious. The disruption of blood return to the heart results in cosmetic problems, among other things. As a result of the insufficiency, the veins dilate at the surface. This aesthetic complication can be very burdensome in everyday life and have a negative impact on the daily life of the affected person. Inferiority complexes and social isolation are possible consequences.In a later stage of the disease, ulcers may develop on the lower legs. The treatment of these ulcers is very lengthy. In addition, these ulcers can regress again and take a chronic course. They can make the patient’s daily life very difficult and lead to restrictions in flexibility and mobility. In addition, wound healing is often impaired. As a result, massive inflammations can develop from small tears and cuts on the skin. Another possible complication is inflammation of the subcutaneous fatty tissue. This infection is better known by its technical term, cellulites. Venous insufficiency initially occurs in the superficial venous system. However, with inadequate treatment, the insufficiency may also spread to deeper venous areas. The formation of thromboses in the leg veins is then possible. Thromboses can detach from their site of formation and travel through the bloodstream. Subsequently, there is a risk that they will clog blood vessels. In rare cases, therefore, very serious complications such as pulmonary embolism, heart attack or stroke are also possible. In the worst case, these complications can be fatal.
When should you see a doctor?
Since there is no self-healing in this disease, a doctor must be consulted in any case. The disease can lead to serious complications and discomfort, so early treatment has a positive effect on the life expectancy of the affected person. A doctor should be consulted if the affected person suffers from swelling and pain in the legs. In many cases, the legs themselves feel heavy and there are restrictions in movement. Furthermore, disturbances in blood circulation or signs of paralysis can also be indicative of this disease and must therefore be examined by a doctor. A visit to the doctor is also advisable in the case of sudden reddening of the skin or severe itching in order to clarify these complaints. As a rule, this disease can be detected by a dermatologist or by a general practitioner. Further treatment depends strongly on the severity of the disease, so that the support of other specialists may also be necessary.
Treatment and therapy
Once the treating physician has clearly diagnosed chronic venous insufficiency, he or she will initiate a therapy that primarily pursues an improvement of the health condition and an alleviation of the symptoms. To achieve this, the venous pressure in the affected region must be regulated, i.e., the blood must be able to be reliably pumped toward the heart. To this end, the patient should wear medical support stockings and ensure that he elevates his legs as often as possible. Furthermore, it is beneficial to integrate sport and exercise into everyday life. The consumption of stimulants, especially alcohol and nicotine, must be reduced or avoided altogether. If these methods are not sufficient, the chronic venous insufficiency can be treated with medication or ultimately also surgically. For example, surgical sclerotherapy of the affected vein or parts of the vein can take place under certain circumstances. Their task is then taken over by surrounding veins. Whether surgery is suitable or not (for example, because the veins are too deep) depends on the individual case. Since chronic venous insufficiency is not curable, the patient will most likely have to adhere to certain behavioral rules throughout his or her life in order to keep the symptoms as low as possible.
Outlook and prognosis
Chronic venous insufficiency has an individual prognostic outlook. Significantly, the success of recovery depends on the presenting cause as well as the patient’s health status. In people in middle adulthood with a healthy immune system, the prospects of recovery are favorable. Freedom from symptoms is achieved within a few months. With good medical treatment, even patients of advanced age experience recovery. The time to recovery is usually prolonged in these patients. The prerequisite for freedom from symptoms is that no other diseases are present and the wound treatment is carried out very carefully and conscientiously. The quality of varicose vein and compression treatment is crucial for successful healing. The patient must be disciplined and careful in dealing with the needs of his body and initiate the steps of healing together in consultation with a physician.If wound care is carried out under the patient’s own responsibility, complications and delays are more likely to occur. With a prevalence of 5%, ulcers occur in patients with chronic venous insufficiency. These can form repeatedly and lead to recurrent impairment. Doctors refer to these cases as ulceration. In extremely rare cases, patients suffer an open leg and thus a leg ulcer. This greatly diminishes the prospects for recovery.
Prevention
Chronic venous insufficiency is often caused by the lifestyle of the affected person. Those who want to prevent the disease should pay attention to regular exercise and engage in sports. Abstaining from alcohol and cigarettes and, in women, from the contraceptive pill can significantly minimize the risk of chronic venous insufficiency. If venous disease is suspected, a doctor should be consulted as soon as possible and treatment initiated.
Follow-up care
After medical treatment for chronic venous insufficiency, it is important for patients to prevent recurrence of problems through aftercare therapy. In everyday life, they should not sit or stand for too long, but should get enough exercise. Activating the leg muscle pump through exercise such as cycling or swimming strengthens the veins. Flat shoes are another effective protection against venous disease. In addition, those affected should avoid excess weight and drink enough. Doctors often recommend medical compression stockings following treatment. These should be tailored precisely to the individual complications. Because only if the calf stockings have the right elasticity and the perfect fit will they support the veins as desired. For this purpose, there is a precise adjustment of the stockings, which should be renewed regularly. The compression stockings adapt to the particular leg shape as well as to the demands. They are tailored for use in normal working life or for sports activities. Consistent and careful observation of the leg veins is enormously important in connection with follow-up care after surgery or other forms of therapy, so that serious damage can be detected in time. Otherwise, a disturbance in blood flow can lead to aggravation, possibly affecting the complete organism.
This is what you can do yourself
Adapting everyday behavior to chronic venous insufficiency and applying self-help measures can have a positive influence on the course of the disease. These may be stand-alone measures or those that accompany medically necessary therapies. In many cases, venous insufficiency is attributed to genetic causes, so that no therapies exist in the sense of combating the causes. This makes it all the more important to follow general behaviors in everyday life to improve symptoms and prevent them. Preventive measures consist of avoiding or at least interrupting long periods of standing or sitting as far as possible. If such periods cannot be avoided, wearing support stockings can prevent, for example, the leg veins from oozing too much and too much venous blood from accumulating in the lower extremities. Active sports that work the leg muscle pump can strengthen the leg muscles that work to support the inner, deep veins, similar to how support stockings work to prevent veins from bulging. Sports such as cycling, swimming, Nordic walking and also climbing stairs favor the function of the venous valves. Sufficient fluid intake and the avoidance of excess weight are also important and helpful in positively influencing the course of the disease. Sufficient fluid intake ensures adequate flow of the blood. Warm and cold alternating baths also have a favorable effect on the function of venous valves.
