What is venous insufficiency?

Quick Answer
An abnormality characterized by decreased blood return from the legs to the trunk that is caused by inefficient valves in the veins.
Expert Answers
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Causes and Symptoms

Venous insufficiency can be either reversible (acute) or irreversible (chronic). It is caused by conditions that increase the amount of circulating blood combined with a decrease in venous flow and is most commonly manifested by thrombophlebitis, varicose veins, and leg ulcers. Thrombophlebitis and varicose veins may be reversible in acute insufficiency.

Thrombophlebitis is an inflammation of the vein, commonly occurring in the legs. It may impede blood flow, resulting in pain, tenderness, redness, warmth along the vein, and edema (swelling). Thrombi (clots) may also form, enlarge, break off, and produce an embolus (dislodged clot), obstructing circulation and causing death. Varicose veins are large, protruding, and painful veins unable to return blood adequately to the trunk as a result of inefficient valves. They may be caused by pregnancy, congenital valve or vessel defects, obesity, pressure from prolonged standing, and poor posture. Leg ulcers are open, draining, painful wounds resulting from an inadequate supply of oxygen and other nutrients. They may also develop on skin surrounding varicose veins because of the stasis (slowing or halting) of the blood flow.

Treatment and Therapy

The treatment for thrombophlebitis includes rest; leg elevation; warm, moist heat to decrease pain and discomfort; and anticoagulant (blood-thinning) therapy to assist with circulation and to impede clot formation. Elastic stockings or bandages assist the return of blood to the heart. Drugs may be used to dissolve clots and to dilate vessels, improving circulation.

The conservative treatment of varicose veins includes the use of elastic stockings or bandages and rest. Aggressive treatment may include injecting the vein with sclerosing agents to occlude it and stop blood flow, thereby collapsing it. Surgical treatment may include ligating (tying off) the vein and then stripping and removing it.

Leg ulcer treatment includes debridement (the chemical or surgical removal of dirt or dead cellular tissue), cleansing and dressing the wound with ointments, pressure bandages, and the application of medicated castlike (unna) boots. Skin grafting may be attempted if other measures are not effective.

Bibliography

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Carson-DeWitt, Rosalyn, and Michael J. Fucci. "Varicose Veins." Health Library, Mar. 13, 2013.

"Chronic Venous Insufficiency." Vascular Disease Foundation, Mar. 15, 2012.

Cohen, Barbara J., et al. Memmler’s The Human Body in Health and Disease. 12th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.

Dugdale, David C. III, and David Zieve. "Deep Venous Thrombosis." MedlinePlus, Feb. 19, 2012.

Ernst, Calvin B., and James C. Stanley, eds. Current Therapy in Vascular Surgery. 4th ed. St. Louis, Mo.: Mosby, 2001.

Grossman, Neil, and David Zieve. "Venous Insufficiency." MedlinePlus, June 27, 2012.

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Loscalzo, Joseph, and Andrew I. Schafer, eds. Thrombosis and Hemorrhage. 3d ed. Philadelphia: Lippincott Williams & Wilkins, 2003.

Mohrman, David E., and Lois Jane Heller. Cardiovascular Physiology. 7th ed. New York: Lange Medical Books/McGraw-Hill, 2010.