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Venous Insufficiency

Definition

Venous insufficiency is described as abnormal blood flow through veins that can cause local damage, damage to affected legs, or death.

Description

Syndromes related to venous insufficiency are caused by valve incompetence. Venous insufficiency is a chronic (long term) condition. The number of new and existing cases is dependent on age and gender. Some patients may have a positive family history. Usually older persons and females are more commonly affected. Deep situated and superficial veins can be affected. Cancer obstructing veins in the pelvis area can cause superficial venous insufficiency. Deep venous insufficiency is commonly caused by thrombophlebitis, causing obstruction of valves that regulate blood flow in veins. Small veins that have been occluded by a thrombosis may re-canalize (opening up new channels to re-direct blood flow). These re-canalized veins are inadequate and cannot correct the impairment of flow. However, larger veins may still remain occluded. When a thrombosis occurs the valves that regulate venous blood flow become thickened and incompetent, rendering them incapable of regulating back flow of blood. This valvular incompetence will cause an increase in the presence within veins (venous hypertension). Venous hypertension is responsible for most of the symptoms associated with venous disease. Superficial veins can become dilated causing varicose veins (veins that bulge and seem tortuous). Leg ulcers can be severe and are responsible for 100,000 cases of disability in the United States alone.

Causes and symptoms

The symptoms of chronic venous insufficiency can be subjective and objective. Subjective symptoms include throbbing, cramping, burning sensations, and leg fatigue. Patients can also develop chronic leg ulcers that may not heal. Varicose veins in the legs can bleed (since veins are delicate structures with thin walls) and cause death. Patients often develop fluid retention (edema) in the affected limb. Skin changes can occur and affected areas can become thin, shiny, discolored (blue-purple), and atrophic. The skin usually becomes thick and tough.

Diagnosis

There are several techniques used to diagnose venous disease. Electrical impedance plethysmography (IPG) provides a functional evaluation for outflow obstruction ultrasound (a machine that transmits sound waves) studies can visualize the venous system in certain areas. Another technique called duplex scanning can measure velocity within a vein.

Treatment

Periodic elevation of legs and bed rest can help with leg swelling. Patients are advised to avoid prolonged periods of standing or sitting. Wearing compression stockings can also reduce swelling of the leg. Mild skin infections can be treated with compresses, steroids, and, if infection is present, with antibiotics. Ulcerations can be treated with compresses, possible surgery, special ointments, and a semi-rigid boot that helps improve blood flow. Varicose veins can be treated with elastic stockings. About 15-20% of patients require surgery, but only after careful evaluation and specialized testing confirms a beneficial value.

Prognosis

The prognosis is variable and depends on the progression of disease, extent of damage, and the presence of other diseases, which may affect the cardiovascular system.

Prevention

Persons who have a strong family history, evidence of disease, and/or those who stand on their legs many hours daily should discuss the option of elastic stocking with their primary clinician.

Resources

Books

Goroll, Alan H., et al. Primary Care Medicine. 4th ed. Lippincott, Williams & Wilkins, 2000.

Townsend, Courtney M. Sabiston Textbook of Surgery. 16th ed. W. B. Saunders Company, 2001.

Key terms

Atrophic — A wasting of cells and tissues.

Thrombophlebitis — Venous inflammation with formation of a thrombus.

Thrombus — A clot in the cardiovascular system (the system that circulates blood throughout the body).

insufficiency /in·suf·fi·cien·cy/ (-sah-fish´in-se) inability to perform properly an allotted function.

adrenal insufficiency

1. hypoadrenalism; abnormally diminished activity of the adrenal gland.

2. adrenocortical i.

adrenocortical insufficiency abnormally diminished secretion of corticosteroids by the adrenal cortex, as in Addison's disease.

aortic insufficiency defective functioning of the aortic valve, with incomplete closure resulting in aortic regurgitation.

cardiac insufficiency heart failure.

coronary insufficiency decrease in flow of blood through the coronary blood vessels.

insufficiency of the externi deficient power in the externi muscles of the eye, resulting in esophoria.

ileocecal insufficiency inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.

insufficiency of the interni deficient power in the interni muscles of the eye, resulting in exophoria.

mitral insufficiency defective functioning of the mitral valve, with incomplete closure causing mitral regurgitation.

pulmonary insufficiency defective functioning of the pulmonary valve, with incomplete closure causing pulmonic regurgitation.

thyroid insufficiency hypothyroidism.

tricuspid insufficiency defective functioning of the tricuspid valve, with incomplete closure causing tricuspid regurgitation; it is usually secondary to systolic overload.

valvular insufficiency

1. dysfunction of a cardiac valve, with incomplete closure resulting in valvular regurgitation; named for the valve involved.

2. venous i.

velopharyngeal insufficiency failure of velopharyngeal closure due to cleft palate, muscular dysfunction, etc., resulting in defective speech.

venous insufficiency inadequacy of the venous valves with impairment of venous drainage, resulting in edema.

vertebrobasilar insufficiency transient ischemia of the brain stem and cerebellum due to stenosis of the vertebral or basilar artery.

venous insufficiency

Inadequate drainage of venous blood from a part, resulting in edema or dermatosis.

venous insufficiency,

an abnormal circulatory condition characterized by decreased return of venous blood from the legs to the trunk of the body. Edema is usually the first sign of the condition. Pain, varicosities, and ulceration may follow. Treatment usually consists of elevation of the legs, use of elastic hose, and correction of the underlying condition.

venous insufficiency (vēˑ·n

s in·s

·fiˑ·shen·sē),

n a condition of the circulatory system distinguished by a noticeable decrease in the return of venous blood from the legs to the trunk. Edema is the first indication of the condition and is followed by ulceration, varicosity, and pain. Treatment includes correcting the underlying source of the condition, elevating the legs, and using elastic stockings.

insufficiency

inability to perform properly an allotted function.

adrenal insufficiency

hypoadrenalism.

aortic insufficiency

inadequacy of the aortic valve, permitting blood to flow back into the left ventricle of the heart.

cardiac insufficiency

inability of the heart to perform its function properly; heart failure.

coronary insufficiency

decreased supply of blood to the myocardium resulting from constriction or obstruction of the coronary arteries, but not accompanied by necrosis of the myocardial cells. Called also ischemic myocardial necrosis.

hepatic insufficiency

inadequate liver function, short of hepatic failure.

ileocecal insufficiency

inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.

pulmonary insufficiency

insufficiency of the pulmonary valve, permitting blood to flow into the right ventricle of the heart.

respiratory insufficiency

a condition in which respiratory function is inadequate to meet the body's needs when increased physical activity places extra demands on it. See also respiratory insufficiency.

thyroid insufficiency

hypothyroidism.

valvular insufficiency

failure of a cardiac valve to close perfectly, causing the blood to flow back through the orifice (valvular regurgitation); named, according to the valve affected, aortic, mitral, pulmonary or tricuspid insufficiency.

velopharyngeal insufficiency

failure of velopharyngeal closure due to cleft palate, muscular dysfunction, etc., resulting in defective swallowing with regurgitation through the nose.

venous insufficiency

inadequacy of the venous valves with impairment of venous drainage, resulting in edema.

venous insufficiency

Internal medicine A state in which one or more veins do not allow normal blood flow due damage of internal valves, resulting in leakage and pooling of blood in legs and feet Clinical Swelling and dull aching, heaviness, cramping of legs, discoloration of overlying skin. See Deep venous thrombosis, Stasis dermatitis, varicose veins.