Chronic venous insufficiency

The term chronic venous insufficiency In medicine, describes a venous disease in which a so-called congestion syndrome occurs in the veins. It is particularly common in the legs and leads to water retention and skin changes. The disease can be treated in different ways, which can lead to a significant alleviation of the symptoms.

What is chronic venous insufficiency?

Chronic venous insufficiency is a disease mostly affecting the leg veins, affecting both the superficial and deep veins.

The function of the affected veins is initially slight due to the insufficiency and then severely restricted. It is not uncommon for chronic venous insufficiency to be based on a previous thrombosis. Since it is a chronic condition, the disease is permanent and cannot be cured.

However, it can be alleviated with appropriate therapy and certain rules of conduct. According to statistics, up to 10% of all adult Germans are affected by chronic venous insufficiency, with women falling ill more often.

causes

The causes of chronic venous insufficiency are only in the rarest of cases due to congenital venous insufficiency. Mostly it is personal risk factors and the individual lifestyle that contribute to the occurrence of the disease.

If there is an increased incidence of chronic venous insufficiency in the family, the likelihood of illness is higher than without this previous burden. People who largely sit down and do not get much exercise in their free time are particularly at risk.

Obesity, shoes that are too tight, smoking or, for women, taking hormonal contraceptives ("pill") can also contribute to chronic venous insufficiency with increasing age.

Symptoms, ailments & signs

Since the blood can no longer flow out of the leg veins as usual in chronic venous insufficiency, the pressure in the leg veins increases and there is a feeling of heaviness or tension. Usually there is also a dull, dragging pain. These symptoms are especially aggravated by long walking and standing.

Chronic venous insufficiency is divided into three stages based on other symptoms. In the first stage, reversible edema appears, i.e. accumulations of fluid in the lower legs that recede when the legs are raised. In addition, the enlarged veins are particularly visible in the area of ​​the ankles in the form of so-called flask veins.

Dark blue skin vein changes can be observed over the edges of the foot. In stage 2 the edema does not recede and the legs are permanently swollen. There are red-brown discoloration of the skin in the area of ​​the lower legs and white spots mostly above the hocks.

So-called congestive eczema, an itchy skin rash, can also develop in the affected areas. Doctors speak of stage 3 when the skin dies, known as necrosis. This defect usually extends deep into the skin and is very difficult to heal. The leg that is now open is called the leg ulcer.

Diagnosis & course

Often a chronic venous insufficiency can be recognized by the attending physician from existing skin changes on the lower leg and foot.

In addition to a detailed conversation, the legs are scanned and examined with the ultrasound device. The venous pressure is determined with the help of a photoplethysmography. In this way, it can be determined exactly whether, where and how far the veins are narrowed.

In addition, a prognosis can be made as to whether and how the disease can be treated. The course of chronic venous insufficiency depends on the individual case. If left untreated, swelling and subsequent skin and tissue changes usually occur. In the worst case, a so-called open leg can develop, which is painful and difficult to treat.

Complications

Chronic venous insufficiency can lead to various, sometimes very serious, complications. The disruption of the blood flow back to the heart results in cosmetic problems, among other things. As a result of the insufficiency, the veins on the surface expand.

This aesthetic complication can be very stressful in everyday life and have negative effects on the everyday life of those affected. Inferiority complexes and social isolation are possible consequences. In a later stage of the disease, ulcers may develop on the lower legs. The treatment of these ulcers is very tedious.

In addition, these ulcers can regress again and take a chronic course. They can make everyday life very difficult for patients and lead to restrictions in flexibility and mobility. In addition, wound healing is often disturbed. As a result, massive inflammations can develop from small cracks and cuts in the skin.

Another possible complication is inflammation of the subcutaneous fat. This infection is better known by its technical term, cellulites. Venous insufficiency first occurs in the superficial venous system. In the event of inadequate treatment, however, the insufficiency can also spread to deeper vein areas. Then the formation of thromboses in the leg veins is possible.

Thromboses can become detached from their place of formation and migrate through the bloodstream. As a further consequence, there is a risk that they block blood vessels. In rare cases, very serious complications such as a pulmonary embolism, a heart attack or a stroke are possible. In the worst case scenario, these complications can be fatal.

When should you go to the doctor?

Since this disease does not heal itself, a doctor must be consulted in any case. The disease can lead to serious complications and complaints, so that early treatment has a positive effect on the life expectancy of the person affected. A doctor should then be seen if the person has swelling and pain in their legs. In many cases, the legs themselves feel heavy and movement is restricted.

Furthermore, disorders of the blood circulation or symptoms of paralysis can indicate this disease and must therefore be examined by a doctor. A visit to the doctor is also advisable in the event of sudden reddening of the skin or severe itching to clarify these symptoms. Usually this disease can be detected by a dermatologist or a general practitioner. Further treatment depends largely on the severity of the disease, so that the support of other specialists may be necessary.

Doctors & therapists in your area

Treatment & Therapy

If the attending physician has clearly diagnosed a chronic venous insufficiency, he will initiate therapy that primarily aims to improve the state of health and alleviate the symptoms.

To do this, the venous pressure in the affected region must be regulated, i. That is, it must be possible to reliably pump the blood towards the heart. For this purpose, the patient should wear medical support stockings and ensure that they raise their legs as often as possible. Furthermore, it is beneficial to integrate sport and exercise into everyday life. The consumption of stimulants, especially alcohol and nicotine, must be reduced or avoided entirely.

If these methods are not sufficient, the chronic venous insufficiency can be treated with drugs or, ultimately, surgically. For example, surgical obliteration of the affected vein or venous parts can take place under certain circumstances. Their task is then taken over by the surrounding veins.

Whether an operation is suitable or whether it can be omitted (for example because the veins are too deep) depends on the individual case. Since chronic venous insufficiency cannot be cured, there is a high probability that the patient will have to adhere to certain rules of conduct throughout his life in order to keep the symptoms as low as possible.

Outlook & forecast

Chronic venous insufficiency has an individual prognostic outlook. The success of the healing process depends largely on the cause and the patient's state of health. Mid-adult people with healthy immune systems have good prospects of recovery.

Freedom from symptoms is achieved within a few months. With good medical treatment, elderly patients can also experience healing. The time to recovery is usually longer in these patients.

The prerequisite for freedom from symptoms is that there are no other diseases and that the wound is treated very carefully and conscientiously. The quality of the varicose vein and compression treatment are decisive for successful healing. The patient must deal with the needs of his body in a disciplined and careful manner and initiate the steps of healing together in consultation with a doctor.

With independent wound care, there are more complications and delays. With a prevalence of 5%, ulcers occur in patients with chronic venous insufficiency. These can develop repeatedly and repeatedly lead to impairments. Doctors speak of ulceration in these cases. In extremely rare cases, patients suffer from an open leg and thus a leg ulcer. This greatly diminishes the chances of a cure.

prevention

Chronic venous insufficiency is often caused by the individual's lifestyle. If you want to prevent the disease, you should pay attention to regular exercise and do sports. Refraining from alcohol and cigarettes, as well as taking birth control pills in women, can significantly reduce the risk of chronic venous insufficiency. If a venous disease is suspected, a doctor should be consulted as soon as possible and treatment initiated.

Aftercare

After medical treatment for chronic venous insufficiency, it is important that patients prevent recurring problems through follow-up therapy. In everyday life, you shouldn't sit or stand too long, but move around sufficiently. Activating the leg muscle pump through exercise such as cycling or swimming strengthens the veins. Flat shoes are another effective protection against venous disease.

In addition, those affected should avoid being overweight and drink enough. Doctors often recommend medical compression stockings after treatment. These should be tailored precisely to the individual complications. Because only if the calf stockings have the right elasticity and the perfect fit will they support the veins as desired.

For this purpose, the stockings are precisely adjusted and should be renewed regularly. The compression stockings adapt to the respective leg shape and requirements. They are tailored for use in normal professional life or for sporting activities.

Consistent and careful observation of the leg veins is extremely important in connection with follow-up care after an operation or another form of therapy so that serious damage can be recognized in good time. Otherwise, a disturbance in the blood flow can lead to an aggravation, which may affect the entire organism.

You can do that yourself

Adapting behavior in everyday life to chronic venous insufficiency and applying self-help measures can have a positive influence on the course of the disease. This can be the sole measure or measures that accompany medically necessary therapies. In many cases, the insufficiency of the veins is attributed to genetic causes, so that no therapies exist to combat the causes. It is all the more important to follow general daily behaviors to improve symptoms and prevent them.

Precautionary measures consist in avoiding or at least interrupting long periods of standing or sitting. If such periods cannot be avoided, wearing support stockings can prevent, for example, the leg veins from sagging too much and too much venous blood from collecting in the lower extremities. With active sport that stresses the leg muscle pump, the leg muscles can be strengthened, which counteracts a bulging of the veins for the inner, deep-lying veins, similar to support stockings. Sports such as cycling, swimming, Nordic walking and climbing stairs promote the function of the venous valves.

Adequate fluid intake and avoidance of obesity are also important and helpful for positively influencing the course of the disease. An adequate supply of fluids ensures that the blood flows well. Warm and cold alternating baths also have a positive effect on the function of venous valves.