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Chronic Venous Insufficiency

Chronic venous insufficiency is a fairly common condition that affects 2-5% of Americans. Common symptoms of chronic venous insufficiency include pain, swelling of the lower leg, lipodermatosclerosis (a scarring of the skin and fat in the ankle area where the skin becomes brown and hard over time), and venous ulceration. Varicose veins are usually present in patients with chronic venous insufficiency. Risk factors for the condition include increased age, a history of DVT, obesity and a sedentary lifestyle.


Causes of Chronic Venous Insufficiency

Chronic venous insufficiency begins when the blood pressure in the veins of the lower leg increases (venous hypertension). This can be caused by a number of factors, although a primary cause relates to muscle activity of the lower leg. When we walk around, the muscles in our calves help to squeeze deep veins and facilitate the return of deoxygenated blood to the heart. This mechanism is known as the 'calf muscle pump'. During long periods of sitting or standing (or if our leg muscles become weak), this mechanism is inactive and the venous pressure in the lower leg increases. Over time and as this is repeated, the vein walls may begin to 'give' and stretch out due to the sustained pressure, and the one-way valves in these veins will begin to fail. When these valves fail (a condition know as venous reflux), the blood flows backwards and begins to pool in the lower leg, further increasing venous pressure. This venous reflux and hypertension can subsequently cause additional vein dilation and valve failure and affect a larger area. The pooling of blood in the lower leg (a condition called venous stasis) can cause fluid to leak into the local tissue, causing swelling and tissue damage. Eventually, these conditions may lead to a non-healing venous ulcer.

Other causes of chronic venous insufficiency include blood clots which may occur in veins preventing normal return of blood to the heart. When this occurs in the deeper veins of the leg it is known as a deep vein thrombosis (DVT). DVTs are a very serious condition, as this blood clot can break off and flow towards the lung (a pulmonary embolism), which can be life threatening. Other veins in the leg may be susceptible to inflammation (due to disease or an injury) or 'phlebitis', and as a result may also develop a clot. When clots occur, blood flow is impeded, pressure increases in the lower leg, and the conditions for chronic venous insufficiency are created.

If you are experiencing any of the symptoms of chronic venous insufficiency, it is important to seek the care of a trained, vein specialist.

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