Definition

Venous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart.

See also:

• Deep venous thrombosis
• Stasis dermatitis and ulcers
• Varicose veins

Causes, incidence, and risk factors

Venous insufficiency is caused by problems in one or more deeper leg veins. Normally, valves in your veins keep your blood flowing back towards the heart so it does not collect in one place. But the valves in varicose veins are either damaged or missing. This causes the veins to remain filled with blood, especially when you are standing.

The condition may also be caused by a blockage in a vein from a clot (deep vein thrombosis).

Chronic venous insufficiency is a long-term condition. It occurs because of partial vein blockage or blood leakage around the valves of the veins.

Risk factors for venous insufficiency include:

• History of deep vein thrombosis in the legs
• Age
• Being female (related to levels of the hormone progesterone)
• Being tall
• Genetic factors
• Obesity
• Pregnancy
• Prolonged sitting or standing

Symptoms

• Dull aching, heaviness, or cramping in legs
• Itching and tingling
• Pain that gets worse when standing
• Pain that gets better when legs are raised
• Swelling of the legs

People with chronic venous insufficiency may also have:

• Redness of the legs and ankles
• Skin color changes around the ankles
• Varicose veins on the surface (superficial)
• Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
• Ulcers on the legs and ankles

Treatment

Take the following steps to help manage venous insufficiency:

• Use compression stockings to decrease chronic swelling.
• Avoid long periods of sitting or standing. Even moving your legs slightly will help the blood in your veins return to your heart.
• Care for wounds aggressively if any skin breakdown or infection occurs.

Surgery (varicose vein stripping) or noninvasive treatments for varicose veins may be recommended if you have:

• Leg pain, often described as heavy or tired
• Skin ulcers or sores caused by poor blood flow in the veins
• Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)

References

Bergan JJ, Schmid-Schonbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. 2006;355(5):488-498.

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 68.