Approximately forty percent of individuals in the United States suffer from what is known as venous insufficiency, a condition in which the internal valves of the blood vessels that return deoxygenated blood to the heart become damaged or compromised, causing blood to pool in the lower extremities. The result is a host of uncomfortable leg symptoms, such as itching, pain, swelling, the development of varicosities, and a 'creeping' feeling across the skin of the leg. Venous insufficiency can become dangerous if left untreated, since disruption of blood flow can lead to the formation of blood clots and other complications. Discover precisely how to treat this condition now.
Wear Compression Socks
In the arteries, blood is pumped forcefully throughout the body, ensuring oxygen reaches every capillary. Conversely, the venous system, which returns deoxygenated blood to the heart and lungs, is a low-pressure system that is not pumped but guided back through a series of valves that prevent the blood from flowing backward, especially in the legs. Venous valves are easily damaged by the downward pressure exerted by pregnancy, excess weight, or simply age. When the valves cease to function, blood can no longer move efficiently, and fluid begins to collect in the lower legs, causing the feet and ankles to swell.
Compression socks can help the valves in deep veins of the leg regain some of their function by exerting outside pressure around the leg. Medical-grade compression legwear, which is stronger than the athletic socks or support hose purchased at department stores, must be purchased at a medical supply store or hospital. Individuals should wear compression socks anytime they will be walking around, and especially if they expect be sitting for prolonged periods, such as a car or airplane ride.
Maintain Regular Movement
Individuals with venous insufficiency should maintain regular movement throughout the day, as prolonged sitting and a lack of physical exercise can make symptoms significantly worse. The valves that help shunt deoxygenated blood through the low-pressure venous system take a lot of assistance from the skeletal muscles of the legs. When individuals exercise, even just lightly, the muscles of the lower legs squeeze the veins deep within. The extra muscular boost helps keep blood flowing upward and reduces the pressure placed on already faulty valves.
Everyone should aim to walk for thirty minutes daily several days per week. If an individual prefers a faster pace, bike riding, stationary cycling, or swimming are excellent ways to keep blood flowing and will help build leg muscle tone as well, a continuous source of lower leg pressure. If an individual is on a long car or plane trip, they should be sure to take regular leg-stretching breaks to prevent ankle swelling, cramping, and blood clots.
Medication For Infections And Blood Clots
Severe cases of venous insufficiency can put individuals at risk for lower limb infections and blood clots. The elevated pressure placed on distal tissues by persistent swelling can cause skin and underlying membranes to develop sores and ulcers, which can lead to infections. The backflow and pooling of blood in damaged leg veins, especially below the knee, promotes the formation of deep vein thrombosis, a large blood clot in the vein. Both situations are medical emergencies, and individuals will need to be prescribed medication for infections and blood clots.
Antibiotics may be prescribed to treat ulcerative infections. If a patient develops deep vein thrombosis and venous insufficiency, their doctor will prescribe an oral anticoagulant, both to help break down the current clot and prevent future blood clots from forming. It's crucial to take these medications exactly as directed.
When back-pressure from venous insufficiency goes unchecked for a long time, it can cause the veins of the lower leg to stretch and balloon, especially closer to the surface of the skin, where there is less tissue pressure to resist the force. These stretched veins are commonly known as varicose veins. They are both cosmetically unpleasant and a source of discomfort for individuals who have them.
Smaller and more superficial varicose veins can be treated with sclerotherapy, a medical procedure in which a chemical fluid or foam is injected into the offending varicosity to destroy it. It works by damaging the blood vessel's inner lining, causing it to scar shut and eventually be broken down and reabsorbed by the body. New, healthy blood vessels form in response as an alternative route for blood to return to the heart and lungs. Though considered safe and effective, this procedure is not entirely without risks; there is a small chance of inflammation or infection, or, rarely, the possibility of a blood clot.
Endovenous Thermal Ablation
Endovenous thermal ablation, also known as endovenous laser therapy (EVTA and EVLT), is a medical procedure similar to chemically-based endovenous treatments, but involves the use of laser-focused thermal radiation instead of a chemical irritant to destroy the lining of a damaged vein. These procedures are performed by board-certified vascular surgeons who are specially trained in endovenous therapies.
EVTA is an effective method for dealing with troublesome varicosities and carries the same risks and benefits as previously described. Since it is minimally invasive (the only incision is one that allows access to the laser catheter), recovery time is fairly short, and the procedure itself is relatively painless.
Elevate The Legs When Lying Down
Individuals affected by venous insufficiency are often advised to elevate their legs when lying down as part of their treatment. Elevation of the legs means the legs are propped at a position higher than the heart and rest of the body. When lying down, the legs are typically in a position at the same elevation as the rest of the body. Individuals who have venous insufficiency often experience blood pooling in their legs because the valves within their veins cannot sufficiently push blood back to the individual's heart against the force of gravity. This malfunction makes it difficult for blood to maintain a healthy pattern of circulation in the lower regions of the body, including the legs and feet. When the legs are at the same elevation or lower than the heart, the valves in the veins are left with the full burden of getting blood back to the heart. Placing the legs at a higher elevation then that of the heart allows for easier blood flow through the veins back to the heart. The combination of leg elevation and any compromised effort of the valves in the legs can help keep blood circulating as it should.
Some individuals who have venous insufficiency need to undergo a surgical vein repair to treat the poorly functioning vein. Usually, other non-surgical and less intrusive treatment methods are attempted before resorting to surgical vein repair. While other less invasive techniques can be utilized to seal off or divert superficial veins, deep larger veins affected by venous insufficiency can pose more of a challenge. Because the deep veins in the leg are too critical to be removed or sealed off, they have to be repaired if possible or completely replaced. During the procedure to repair a deep leg vein valve, a surgeon makes a traditional incision to access the affected vein. A mechanism can be used on the outside of the vein to narrow it so the valve can work better, or the valve may need a repair on the interior of the vein. In order to repair the valve on the interior of the vein, the surgeon has to open up the vein so they can see the valve. Sutures are then used to tighten up the valve leaflets to the point where they are able to close correctly. The valve is tested for competency using the strip test before the vein is sutured up.
In cases of venous insufficiency where the affected vein has a valve damaged beyond the point of repair, and the vein is significant enough that it cannot be fully removed or sealed off, a vein transplant procedure may be necessary. This type of surgical procedure involves the removal of the non-functioning valve by cutting both ends of the affected vein above and below the valve. This section of the vein is removed so it can be replaced with another vein similar in size that is typically removed from the individual's arm. The arm vein is transferred to where the non-functional valve was removed. Both ends of the cut leg vein are sutured to both ends of the arm vein containing the functioning valve. A cover is typically placed around the site of the valve transfer to prevent any form of late vein dilation. It is practical for a vein to be taken from the arm to be used for the transplant because the arm has numerous smaller veins that are sufficient enough to move blood back to the heart in the absence of the axillary vein.
In cases where an individual has veins in the legs that are not vital for its functioning, ligation and stripping may be recommended as an option to treat their venous insufficiency. Ligation refers to a surgical procedure not as invasive as a vein bypass, repair, or transplant, where the incompetent vein is cut and tied off so that blood is no longer able to travel through it. This forces blood to route through other healthy veins in the legs to reach the heart. This method can only be utilized when an absence of the affected vein will not exacerbate the severity of the individual's venous insufficiency. When the vein is tied off and has no blood flow, the body eventually breaks it down and absorbs it. However, if the vein is severely damaged, it may need to be removed from the body altogether after being tied off, instead of just cut. The reason behind this is the damaged vein can release toxic byproducts into nearby tissues. The surgeon performing the ligation can determine whether the vein will need to be removed during the procedure.
A vein bypass is a treatment option available for deep leg veins affected by venous insufficiency when a valve repair is not feasible. During a vein bypass, a healthy vein has to be identified in close proximity to the incompetent vein. Once a healthy vein has been identified, the incompetent vein is cut and rerouted to the identified healthy vein. An incision is made in the healthy vein below the location of its valve, and the rerouted vein is sutured to that opening. In some cases, the rerouted vein may need to be lengthened or modified in another way before it can be successfully sutured into the healthy vein. This rerouting allows for the blood to bypass the part of the incompetent vein where the non-functional valve is located and go directly into another vein with a working valve. While this procedure has shown to be helpful for many individuals with venous insufficiency, it is not always a permanent solution. The healthy valve has to be able to support the extra workload of the rerouted blood. In some cases, the healthy valve becomes damaged or worn out, and further intervention is needed at a later time.