Venous insufficiency is a common cause of leg pain and swelling. It is a condition that occurs when vein walls lose elasticity and/or the effectiveness of the one-way valves is reduced. This results in a backflow of blood and pooling in the veins.
Venous Insufficiency most commonly manifests as varicose veins, swollen and aching legs, skin changes or leg ulcers. It is quite common for patients to have venous insufficiency without having visible signs of varicose veins.
It is possible for patients to have VI alone, VI associated with varicose veins, or varicose veins without VI.
In order to assist with classifying the varying degrees of venous insufficiency, the CEAP clinical classification system was introduced in 1994. This system ensures universal standardisation of identifying and treating disorders associated with venous insufficiency.
The CEAP clinical classification system uses a combination of four factors: severity, cause, location and specific abnormality and consists of the following seven grades:
C0 – No evidence of venous disease
C1 – Superficial spider veins (reticular veins) only
C2 – Simple varicose veins only
C3 – Ankle oedema of venous origin (not foot oedema)
C4 – Skin pigmentation in the gaiter area
C5 – A healed venous ulcer
C6 – An open venous ulcer
The estimated prevalence of Venous Insufficiency in Western populations is around 10-15% for men and 20-25% for women, and increases with age.
- Family history of Venous Insufficiency
- Family history of Deep Vein Thrombosis in the legs
- Age – more common among older people
- Height – being tall means the veins have to work harder
- Being female – higher levels of the hormone progesterone can act as a muscle relaxant, hindering the muscles pumping ability
- Obesity – increased pressure on the body
- Pregnancy – increased hormone levels and increased pressure on the body
- Sitting or standing for long periods of time – increased pressure due to gravity
Your veins and arteries are part of your circulatory system. Arteries pump blood around your body. Once oxygen and nutrients are delivered, your blood flows into your veins, some of which are just below the skin. The forward flow of blood is ensured through:
- One way valves in the veins, preventing back flow
- Your calf muscles squeezing the blood toward your heart when you move about
- Your arteries transmitting energy to the veins to propel blood towards the heart
- Elasticity, as veins stretch and contract to help with upward blood flow
However, the effectiveness of these valves and the elasticity of your vein walls can be damaged or reduced, which results in the back flow and pooling of blood in your veins. Your veins then engorge and dilate. This is called venous insufficiency. In the larger vessels venous insufficiency can lead to varicose veins, whilst in the smaller more superficial vessels and capillaries reticular and spider veins can result.
Commonly, they occur in the legs because the veins in your lower extremities have to overcome gravity and endure the most pressure to move blood back to your heart. If the pressure is stronger than the one-way valves and vein wall tone, varicose and spider veins develop.
The seriousness of venous insufficiency increases as the condition progresses, so it’s important to see your Doctor as soon as the symptoms present themselves. Symptoms can include:
- Swelling of the legs
- Heaviness, cramping or aching in the legs
- Pain that increases when standing
- Redness of legs and ankles
- Varicose veins
- Hardening of the skin, ulcers or slow-healing wounds on the legs or ankles
Untreated venous insufficiency can lead to any of the following conditions:
- Spider veins
- Varicose veins
- Leg ulcers or sores
- Serious infection
- Blood clots, including Deep Vein Thrombosis
Fortunately there are painless and minimally invasive procedures to treat and manage varicose veins. Such treatment can dramatically ease discomfort or pain, avert complications, improve appearance and stop disease progression.