Q&A: What is chronic venous insufficiency? A vascular surgeon answers

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Up to 40% of adults in the United States have chronic venous insufficiency, a condition in which veins in the legs don’t function properly, preventing blood flow back to the heart. Miguel F. Manzur, MD, a vascular surgeon with the USC Cardiac and Vascular Institute, part of Keck Medicine of USC, shares what you need to know about chronic venous insufficiency, including symptoms, treatment and prevention.

What is chronic venous insufficiency?

Chronic venous insufficiency is a disease that involves the veins of the legs. Over time, the valves in those veins stop working. Because the valves aren’t working properly, blood can’t travel up the leg back up to the heart. Instead, the blood pools in the lower leg. That can lead to swelling of the legs or the legs feeling heavy and tired, varicose veins, skin discoloration and sometimes ulceration. The main symptom people usually have is leg swelling.

Who is at risk of chronic venous insufficiency?

There are several risk factors. One is simply getting older. The risk of chronic venous insufficiency increases once patients are over the age of 50.

Another risk is gender. Females are more likely to develop chronic venous insufficiency due to pregnancy, which causes increased blood volume, and hormonal changes that can lead to issues with veins.

Genetics also play a strong role. If a family member, such as your mother or aunt, had issues with their veins, you’re more likely to develop similar issues.

Other risk factors include obesity or a sedentary lifestyle. Sitting or standing for prolonged periods of time tends to affect normal, healthy blood flow.

Finally, patients who have had deep vein thrombosis in the past—which is when a blood clot occurs in a deep vein, usually in the legs or pelvis—are at higher risk.

How is chronic venous insufficiency diagnosed?

Leg swelling can stem from different causes, so a doctor needs to rule out other potential causes. For instance, older patients may have other medical issues, such as congestive heart failure or kidney or liver disease, that can cause swelling. Medications can also cause leg swelling. Blood clots in the veins can lead to leg swelling as well. Finally, although it’s less common, lymphedema, which is the retention of fluid and due to a backup in the lymphatic system, can also cause leg swelling.

It all starts with a physical exam. Doctors will start by examining the appearance of your leg. If there are a lot of spider veins or varicose veins, or if the leg looks like it’s swollen or brown, those are telltale signs of chronic venous insufficiency.

Next, we’ll do what’s called a venous reflux ultrasound, which is a noninvasive diagnostic test to assess how the valves in your vein are working. If blood is refluxing, or flowing backwards, your valves could be faulty and causing chronic venous insufficiency.

How is chronic venous insufficiency treated?

It depends. For some patients, chronic venous insufficiency is more of an inconvenience. Their legs may feel heavy, tired, painful or itchy. For these patients, we usually we start by with lifestyle changes. We recommend that patients start walking as much as they can and avoid standing or sitting for prolonged periods of time. When you walk, your leg muscles act as pumps to get your blood moving. Every time the calves and thighs contract, it allows the veins to open and close and get the blood to go back up your leg.

Other recommendations include losing weight and elevating the legs, which can help with swelling. Another first-line treatment is wearing compression stockings.

Patients with chronic venous insufficiency that has gone untreated for a very long time and those who have had deep vein thrombosis in the past can present with more debilitating issues such as skin discoloration, called lipodermatosclerosis. This can eventually lead to skin ulcerations on the leg. It’s important to get proper wound care to get those ulcers to heal so they won’t get infected.

We may also work with their primary care doctor to prescribe changes in medication, such as starting a diuretic. To treat skin irritations like dermatitis or ulcerations, we may recommend a topical steroid.

If swelling is still bad following these more conservative measures, we can do venous ablation to remove the damaged vein, either through a minimally invasive procedure or combined with medication to help close the vein. This procedure can be done quickly in a doctor’s office. It usually takes about 20–30 minutes, and patients can go home right afterward. Other procedures include stenting or phlebectomy, which is also a minimally invasive procedure that can be done in-office.

Can chronic venous insufficiency be completely cured?

Treatments can work very well and last for many years. However, this is a chronic problem that can always arise again. For instance, another varicose vein could develop, especially if the patient had an ulceration wound. We always recommend that patients and their primary care doctor stay in communication with a vein specialist. If someone has a more extensive disease, they may require additional treatment down the road.

How do you manage chronic venous insufficiency when traveling?

Sitting for a long time, such as on an airplane or a car, can exacerbate leg swelling and discomfort. I recommend that patients who are going to be on a flight or sitting down for a long time buy compression socks or wear ones that I prescribe them.

While they’re on the plane, they should try to elevate their legs if possible, and they should get up every hour or so and walk up and down the aisle, just to get their blood moving. While seated, they can do calf pumps to get the calves engaged and get the blood moving. If it’s a long car ride, they can stop every hour or so to walk around for a couple minutes.

Here’s what to know about chronic venous insufficiency