Chronic Venous Insufficiency

Chronic Venous Insufficiency is the most common cause of leg swelling, affecting approximately 2% of the general population and up to 20% of the elderly population.  The condition affects about 2.5 million people in the U.S. alone. 

Symptoms of chronic venous insufficiency include swelling of both legs, with a feeling of “heaviness” being a common complaint.  An itchiness or constant dull pain is often reported, and symptoms will typically worsen through the day or after a long period of standing.  Skin changes are a common finding in chronic venous insufficiency, with the skin first changing to a darker color.  This is often associated with excessive dryness and flaking of the skin, known as stasis dermatitis.  As the condition progresses, the skin becomes thicker and taught, and becomes prone to breakdown or ulceration. 

The venous system is what is responsible for returning blood from the peripheral tissues back to the heart.  In the legs, gravity allows this blood to pool when the venous system fails in returning the blood.  This is most commonly due to faulty valves in the venous system. 

Normally, the deep venous system returns most of the blood back to the heart.  The superficial venous system shunts blood into the deep system, and valves in the veins connecting the two layers create a one way system.  When these valves fail, it allows for backflow in the venous system, causing pooling and chronic venous insufficiency.  The valves can be damaged from normal aging, blood clots, varicose veins, pregnancy, or injury to the legs or vascular system. 

The gradual development of swelling in both legs at the end of the day is suggestive of venous insufficiency when there is no other obvious cause.  However, the rapid development of swelling or swelling of one leg should be more alarming, and warrants the immediate attention of a doctor.  Some things that can cause swelling of the legs include cellulitis (infection), deep vein thrombosis (blood clot), tear of the calf muscles, ruptured Baker’s cyst, lymphedema, congestive heart failure, liver disease with cirrhosis, and damage to the kidneys.  Obviously some of these conditions are more serious and life threatening than others. 

Chronic venous insufficiency is largely a clinical diagnosis, meaning that advanced testing is usually not necessary.  However, some tests may be ordered to rule out other conditions when the diagnosis is not as clear.  An ultrasound study may be ordered to rule out a blood clot, or a deep vein thrombosis (DVT).  If there is an open wound, blood cultures and swabs of the wound may be taken to identify a possible infection.  Blood work may also be used to evaluate the function of the heart, liver, and kidneys if damage to these organs is suspected. 

Treatment of venous insufficiency depends on how advanced the swelling is.  In early cases, it may be treated with elevation of the legs when possible, walking programs, and light compression stockings. These modalities will help to return the blood to the heart, and prevent the progression of swelling. 

In more advanced cases, compression therapy may be taken on more aggressively, with heavier compression stockings or temporary wraps to bring the fluid out of the legs.  Unna boots are a soft type of cast that is often used for this reason.  Other modalities may include intermittent compression devices that actively squeeze the calf muscles, shunting blood back to the heart.  These machines can be used at home. 

Medications can be prescribed to help control excess fluid as well.  Diuretics, sometimes referred to as “water pills” can help a person to increase their kidney function, which in turn increases their excretion of fluids and urination.  This medications should be used with caution, and are most commonly monitored by the primary physician. 

Aggressive therapy of chronic venous insufficiency can help prevent the complications of the condition.  Most notably, these complications include ulceration and infection.  Ulcerations secondary to venous insufficiency typically begin with a minor traumatic event which opens up the skin.  At the incident, these injuries will usually bleed a disproportionately large amount.  Once the skin is opened, the pressure from fluid build up can cause the wound to expand in a circular pattern.  These wounds are usually found around the ankles, and will typically drain a great deal while they are open.  Venous wounds can be extremely difficult to heal, as the persistent swelling interferes with the normal healing process. 

Infection can persist in one of two ways in the presence of venous insufficiency.  Because of the tendency for people with venous insufficiency to ulcerate, an open wound is created.  This acts as a portal for infection into the body.  The skin changes seen with venous insufficiency also weaken the skin, and take away from its natural infection fighting ability.

Persons with swelling in their legs should be evaluated by a doctor to determine the cause.  Whether it is an immediate life threatening condition causing the swelling, or early signs of venous insufficiency, it should be treated aggressively and appropriately.  

Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. Winter Haven, FL 33881 
Phone: 863-299-4551 
www.FLFootandAnkle.com