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What is Venous Insufficiency?

What is venous insufficiency? Venous insufficiency, also known as venous reflux disease, refers to the dysfunction or leakage of the “one way check valves” in our veins. Our blood vessels function as a circuit. The arteries deliver oxygenated, nutrient-rich blood to our tissues, and our veins work as the return circuit, returning deoxygenated blood to the heart and lungs. Since most of our veins are below the level of our heart, the blood traveling in our veins must fight gravity to return to the heart. In order to carry this blood against gravity, the muscles of the legs squeeze the veins closed any time that you move your legs and contract your muscles. This propels the venous blood upwards towards the heart. In your veins are a series of one-way valves. They snap closed when you are not in moving to prevent the blood from “leaking” in the wrong direction back down towards the feet. When these valves do not close properly, blood will pool in the veins of the legs and feet, and this is known as “venous insufficiency”.

What findings suggest venous insufficiency? Signs and symptoms of venous insufficiency most commonly occurs in our legs and most predominantly in the lower legs, including the ankles and feet, since they are the lowest point in our bodies. Throughout the day, pressure from any blood moving in the wrong direction builds in the veins of the calves, ankles, and feet. As the pressure builds, the veins will often dilate to accept the pressure. These dilated veins are known as varicose veins. The veins also may leak fluid into the surrounding tissue to balance the increasing pressure. This can result in symptoms such as leg swelling, leg heaviness, leg aching, discoloration in the lower legs/ankles, and ultimately can impair wound healing. In order to further evaluate the function of the veins, an ultrasound can assess the competency of the valves to help better define the location of venous reflux.

Is there anything that can be done to help? There are various ways in which venous reflux disease can be treated. Initially, conservative measures are recommended. These include using appropriately fitted
compression stockings, elevating the legs intermittently throughout the day, and participating in a cardiovascular exercise regimen. If these means do not adequately control symptoms and provide relief,
procedural options can be considered. Treating the superficial venous system often entails closing a portion(s) of the leaky vein to reduce the backpressure that develops in the legs throughout the day. This is done by inserting a small catheter into the vein through a nick in the skin. The catheter then emits ultrasound energy into the vein wall or injects a type of fluid into the vein, which causes the vein to
contract down and seal off. The patient’s blood flow will then be diverted by the body into normal functioning veins. This diversion of blood decreases the pressure in one’s varicose veins. When the
pressure is lower in the veins, they will cause less symptoms and shrink in size. If the varicose veins still are symptomatic or cosmetically unacceptable after closing the source veins, the varicose veins can be
removed through a series of tiny incisions, or injected with a type of fluid that causes the veins to shrink and close off, which is called sclerotherapy.

Most patients with venous insufficiency present with symptoms and physical findings in their legs, but patients can also have venous insufficiency in their pelvis, also known as “pelvic congestion syndrome”. Based on the patient’s presenting signs and symptoms, there may be concerns for narrowing or reflux in the veins of the pelvic area. This can cause the pressure to slowly backup in these veins ultimately effecting the pelvis. initial work up of this diagnosis typically involves a CT scan of the abdomen and pelvis to evaluate for any compression of the veins or signs of leaky veins. If the diagnosis is suggested, a venogram, a procedure where a small catheter is placed into the veins of the pelvis to assess whether they have normal appearance and function, is performed. If there is significant compression or narrowing of these veins, a stent may be placed to open the veins and treat any narrowing, allowing the blood to drainage out of the pelvis more efficiently. If the veins are found to be leaky, the veins can be sealed closed by placement of products that will cause the vein to shut down.

Author
Robert Dougherty, PA-C Robert Dougherty, PA-C Mr. Dougherty joined Vascular Surgery Associates in 2014. He received his Physician Assistant Certificate from Anne Arundel Community College and Master of Medical Science from St. Francis University.

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