The condition known as chronic venous insufficiency occurs when vascular damage impedes the body's ability to move blood from the legs towards the heart. This causes blood to pool in the legs, where it can cause swelling, pain and, in some cases, leaking fluid in the skin or ulcers. Chronic venous insufficiency occurs in approximately 5 percent of the U.S. population, notes the Merck Manual for Healthcare Professionals. Options for the management and treatment of chronic venous insufficiency range from changes to daily activities to surgery.
Sitting, Standing and Elevating the Legs
Doctors can advise patients with chronic venous insufficiency on ways to drain the blood collecting in the legs. Those methods include decreasing the length of time spent in sitting or standing positions and trying to elevate the feet while sitting. Elevation of the legs above the level of the heart while lying down makes use of gravitational forces to drain blood through the veins towards the heart.
Compression
A number of treatment options exist for exerting pressure on the legs. That helps improve the flow of blood to the heart. The Merck Manual explains that contractions of the calf muscles play a role in the return of blood towards the heart by pushing blood into the deep veins of the leg. Compression of the legs by artificial means mimics this process and proves effective in the treatment of chronic venous insufficiency. Options include elastic bandages, compression stockings and plastic leggings attached to an air pump.
Treatments for Skin Problems
Along with compression devices, doctors may recommend different treatments for the skin affected by chronic venous insufficiency. In those cases in which no fluid leaks from the skin and no openings have developed on the skin's surface, doctors may suggest a cream, such as a hydrocortisone, to prevent itching. Some may suggest use of a zinc oxide cream for skin protection or an anti-fungal cream to ward off fungal infections, notes the Penn State Milton S. Hershey Medical Center.
Treatment of skin that leaks fluid may include application of wet compresses. In cases where skin ulcers have developed, layers of compression bandages are used rather than compression stockings.
Sclerotherapy
In an article in the 2009 journal "Circulation," Drs. Robert Eberhardt and Joseph Raffetto list a number of interventions to treat chronic venous insufficiency. Those options include sclerotherpy, the injection of a chemical into a vein that causes clotting. The blood vessel eventually turns into scar tissue, and the blood flow is rerouted through other vessels. Some of the chemicals used in sclerotherapy include sodium chloride, sodium morrhuate, polidocanol and sodium tetradecyl sulphate.
Surgical Treatments
Drs. Eberhardt and Raffetto mention a recently-adopted treatment, known as ablative therapy, which uses heat energy to destroy the affected veins. That technique makes use of radio frequency or lasers to apply thermal energy to the veins. Another procedure involves the insertion of stents into the veins. The Merck Manual mentions surgical procedures for treating chronic venous insufficiency, including stripping of veins, ligation or tying off of veins and surgical reconstruction of valves. The publication warns, however, that these procedures are, in general, ineffective.
References
- The Merck Manual for Healthcare Professionals: Chronic Venous Insufficiency and Postphlebitic Syndrome
- Penn State Milton S. Hershey Medical Center: Chronic Venous Insufficiency
- "Circulation"; Contemporary Reviews in Cardiovascular Medicine--Chronic Venous Insufficiency; Robert Eberhardt and Joseph D. Raffetto; 2005
- Medline Plus: Chronic Venous Insufficiency
- University of Maryland Medical Center: Venous Insufficiency--Treatment
