Chronic Venous Insufficiency
Chronic venous insufficiency is a term often used to refer to
the pooling blood in the veins of the lower legs. This condition
may occur in those who are elderly, obese, or extremely inactive.
There is also evidence for a genetic predisposition to chronic
venous insufficiency.
The work of the venous circulatory system is the return of blood
flow back to the heart. To facilitate this process, the valves
within the veins are one-way, thus routing the blood continually
in the direction of the heart. Damage to these valves, a blood
clot in the veins, or an inflammatory process can disrupt the smooth
return of blood flow. The muscular action of the legs and feet
is also essential in promoting the blood flow back to the heart
through the venous circulation. Muscle damage or injury can impair
this ability and allow blood pooling or stasis in the lower extremities.
As the blood pools in the venous circulation and venous pressures
increase, swelling of the legs and feet are often noted. Increasing
venous pressures may result in the bursting of capillaries that
in turn create the reddish-brown discoloration of the surrounding
skin
tissues. This area of damaged skin is easily broken when bumped
or scratched. The circulatory compromise and tissue damage may
create an ulceration that is often referred to as a venous stasis
ulcer. Infection may occur further endangering the healing process.
Other symptoms of chronic venous insufficiency include aching,
painful legs and ankles. The skin of the surrounding area may become
extremely dry and leathery sometimes developing flaking and itching.
Physical examination will determine the diagnosis. A duplex scan
or ultrasound of the lower extremity circulation may be ordered
as well.
Treatment of chronic venous insufficiency often involves the use
of compression stockings to promote the appropriate return of blood
flow back towards the heart. The circulatory compromise will also
require careful observation and meticulous care of the surrounding
skin to avoid the drying and itching effects while ensuring skin
integrity for ulcer and infection prevention. Venous stasis ulcers
require individualized treatment to promote skin healing, treat
infection if present, and prevent further skin damage and infection
spread to surrounding tissues.
Stasis and pooling of blood flow will be discouraged if the legs
are elevated above the heart when seated. Those with chronic venous
insufficiency must flex their calf muscles and feet at very regular
intervals, if remaining seated during a lengthy trip is required.
Weight control and appropriate exercise parameters will be useful
in limiting chronic venous insufficiency and its effects.
