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Venous insufficiency: causes, symptoms, complications, risks, treatment
When blood in the lower limbs has difficulty returning to the heart and becomes stagnant, it’s called venous insufficiency. What causes it? What are the complications of venous insufficiency? Answers by Dr. Katia Salloum, an angiologist.
“Venous return is the stage of blood circulation in which oxygen-poor blood flows back from the lower limbs to the heart, where it becomes oxygenated, through the deep and superficial venous system, ” explains Dr. Salloum.
” Veins are flexible, extensible vessels with thin walls, unlike arteries. These veins are equipped with valves spaced every 4 or 5 mm, which force a one-way flow, from bottom to top, to push blood back toward the heart,” explains Dr. Salloum. In the standing position, blood must defy gravity; this system of valves helps it return to the heart.
What is venous insufficiency? Definition
Venous insufficiency leads to poor venous return. ” Blood from the veins in the lower extremities has difficulty returning to the heart due to the malfunction of the venous valves, which prevents reflux ,” explains the angiologist.
“In cases of venous insufficiency, blood pools in the veins, and because their walls are thin and elastic, they expand due to stagnation, which causes the veins to dilate and, as a result, varicose veins to form,” he adds.
Symptoms of venous insufficiency
Symptoms of venous insufficiency include a feeling of heaviness in the legs, tingling, an urge to move the lower limbs, and swelling of the ankles, feet, and/or calves. Other characteristic symptoms include the appearance of spider veins or varicose veins (dilated capillaries and veins). Itchy eczema may develop at the site of the varicose veins. The final stage is the formation of a varicose ulcer.
Venous insufficiency: risk factors
The main risk factors for venous insufficiency are: female gender, pregnancy, overweight, heredity, age, sedentary lifestyle and certain professions.
Female sexuality and pregnancy
” Women are at greater risk than men due to pregnancy and estrogen ,” confirms Dr. Salloum. ” After a first pregnancy, the risk increases by 20%, and after a fourth, by 30%. Depending on the stage of pregnancy, the uterus compresses the veins, leading to poor venous return, ” she adds.
Overweight
Another significant risk factor is being overweight. ” The legs are subjected to greater pressure, which causes reduced venous return. When the BMI (body mass index) exceeds 25, the risk of developing varicose veins is 25%, ” explains the angiologist.
Heredity
The hereditary factor occurs in more than 70% of cases.
Age
Age is also a risk factor. While it can affect younger people, the older you are, the higher the risk (except for very rare congenital conditions in which babies are born without valves).
Some professions
Certain professions also put individuals at risk for venous insufficiency due to orthostatic hypotension, as the standing position promotes blood stasis. This is particularly true for waiters, chefs, hairdressers, and others.
It should be remembered that a sedentary lifestyle and smoking, causing a loss of tone and mobility of the venous walls, also contribute to the formation of varicose veins.
Complications of venous insufficiency
Untreated venous insufficiency exposes the patient to numerous complications, both chronic and acute.
Chronic complications
” Venous dilation (sometimes up to 8, 9, or 10 mm, or even more in the case of the great saphenous veins, the main veins of the superficial venous system) causes the appearance of varicose veins. This can lead to swelling, edema in the legs, a feeling of chronic heaviness, itching, and the development of eczema, ” explains Dr. Salloum.
If venous insufficiency is not treated, skin complications may also occur: skin pigmentation with ochre dermatitis, chronic and irreversible, or white skin atrophy.
” Ochre dermatitis is the result of ruptured capillaries—small, superficial blood vessels located beneath the skin—leading to massive blood leakage that invades surrounding tissues. Typically, capillary rupture is caused by excessive venous pressure, occurring after the appearance of varicose veins, ” explains the angiologist.
The final stage of venous insufficiency is venous ulceration. This causes a wound to develop on the leg, most often around the ankle. This creates a risk of secondary infection and bleeding.
Acute complications
One of the complications of venous insufficiency is superficial vein thrombosis, also known as paravenous venous thrombosis. “It causes an inflammatory reaction with a red, hot, and very painful vein ,” explains the specialist.
In deep vein thrombosis, a clot can form and travel to the heart, blocking an artery. This can cause a pulmonary embolism, which can be fatal.
Another complication of venous insufficiency is varicose vein rupture. ” This occurs primarily in older adults, in cases of shock or trauma, causing a hemorrhage with bleeding, or a hematoma if the bleeding persists under the skin, ” explains Dr. Salloum.
How to treat venous insufficiency?
The treatment of venous insufficiency covers several aspects.
Compression stockings
Elastic compression is the basic treatment method for chronic venous insufficiency of the lower limbs.
Reduces venous dilation, improves venous return and reduces leg volume (anti-edema effect).
” Some people believe that tights are more effective than stockings or socks, but they are equally effective in reducing venous return. It’s important that they provide compression around the ankle, ” explains the angiologist.
Venotonic drugs
Venotonic medications help relieve the feeling of heaviness and swelling caused by venous insufficiency. They provide symptomatic relief but do not cure the condition once varicose veins are present.
Sclerotherapy
Sclerotherapy is a treatment method for varicose veins that involves injecting a substance through a thin needle, which damages the venous endothelium and gradually destroys the vein wall. ” The varicose vein disappears on its own within a few days or weeks, ” explains the specialist. The procedure can be performed in a doctor’s office.
The most commonly used sclerosing agents in France are polidocanol and sodium tetradecyl sulfate. They are available in liquid form or, increasingly, as a more effective foam.
” The injection itself isn’t painful, but some preparations cause an unpleasant, burning sensation as they penetrate the vein. Paradoxically, microsclerotherapy (or cosmetic sclerotherapy for varicose veins) hurts a bit more, but remains quite tolerable ,” explains Dr. Salloum.
“Endovenous laser sclerotherapy takes about twenty minutes. The duration varies depending on the number of veins being treated and any complications. One of the main complications is venous thrombosis. Therefore, injectable anticoagulants are used to prevent phlebitis, ” explains the specialist.
Side effects are sometimes observed, including discoloration along the superficial vein. This discoloration disappears within a few days or weeks. Mild pain, which responds well to common pain relievers (e.g., paracetamol), as well as neuralgia and inflammation, are also reported, resolving in less than a month.