Chronic Venous Insufficiency and Venous Stasis Ulcers

Healthy veins in our body contain valves that keep blood flowing in one direction toward the heart. Valves of the veins in the legs do an additional effort to oppose the effect of gravity to keep blood flowing back toward the heart. In certain conditions, these valves get affected and struggle to perform its functions allowing blood to reflux backward and pool in to the lower leg facilitated by the effect of gravity. This leads to a condition called Chronic Venous Insufficiency that may become progressive if left untreated. The venous pooling into the lower extremity causing heaviness and aching pain and may also create venous hypertension that leads to blood leaking out of the veins causing the distinctive purplish pigmentation of the skin. Eventually this leads to skin changes, inflammatory eczema, edema, venous ulcers and infection may occur.

 

Risk Factors

Below are list of conditions that is associated with increased risk of developing chronic venous insufficiency:

  • Family history of chronic venous insufficiency.

  • Sedentary life style and lack of exercises.

  • Prolonged setting or standing.

  • Obesity.

  • Trauma or leg injury

  • Pregnancy.

  • Smoking.

 
 

Symptoms

Chronic venous insufficiency is a progressive condition if left untreated. The early detection of the condition can help guide treatment and its progress. These symptoms are:

 

  • Varicose veins

  • Leg pain or aching

  • Leg swelling

  • Leg cramps

  • Leg heaviness or tiredness

  • Leg eczema and itching

  • Restlessness

  • Skin changes

  • Purple or brown discoloration of the leg skin

  • Leg ulcers

  • Cellulitis and infection

 

Diagnosis

A complete medical history and physical exam is obtained by your physician. During the physical exam, the physician will carefully examine your legs. A test called duplex ultrasound may be used to examine the blood circulation in your legs. During the test, a transducer (small hand-held device) is placed on the skin over the vein to be measured and examined. The transducer emits sound waves that bounce back from the vein. These returning sound waves are recorded, providing image of the vessel that can be displayed on a monitor. This allow for visualizing the condition of the vein, measuring its diameter and the reflux time.

 

Treatment

The goal of treatment for vein disease is to prevent the backward flow of blood.

You physician may prescribe you the following based on the severity of the condition:

  • Compression stockings and leg elevation.

  • Removing diseased vein

  • Closing diseased vein (through thermal or non-thermal  treatment)

The progressive symptoms of vein disease are preventable with the proper treatment.

Without treatment, signs and symptoms may progress and significantly affect quality of life, leading to venous leg ulcers.

 

Venous Stasis Ulcer

A common result of venous insufficiency as it fails to return the blood back to the hear. This results in pooling of the blood into the leg veins under the effect of the gravity leading to increased blood pressure in the diseased veins. Eventually, the blood leaks through the tiny blood vessels that surrounds these veins triggering inflammatory changes and further damage of the skin leading to ulcers.

 

Treating venous ulcers is very challenging and take more than 4 weeks to heal. It is very important to treat the wound and its cause enabling the patients to live without the discomfort of these wounds. More than 70% of all lower extremity ulcers are caused from superficial venous insufficiency with about 1 million people in the U.S. are affected by venous leg ulcers. Moreover, recurrence is common in more than half of treated venous leg ulcers.

In most cases, superficial venous reflux is present in patients with venous leg ulcers. However, many venous ulcer patients go unevaluated and untreated for superficial venous reflux.

Symptoms

Venous ulcers are very painful. Pain is often triggered by mobility, therefore, it limit the daily activity of the patient. Moreover, venous leg ulcers leads to recurrent skin infection (cellulitis). Venous leg ulcers have a significant impact on the quality of daily life of the patients.

Causes

Venous leg ulcers are caused by chronic venous insufficiency due to venous obstruction or failure of the venous' valves to direct blood toward the heart leading to reflux to the lower extremity.  Obesity, pregnancy, injury of the vein are also risks factors that may causes venous insufficiency and hence, venous leg ulcers may develop.

 
 

Treatment

The goal of the treatment is to control infection, provide wound care and debridement, compression therapy and to reduce the backward flow of the blood.  Early endovenous ablation of superficial venous reflux with compression therapy heals venous ulcers in shorter time and prevent ulcer recurrence.

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