Venous Insufficiency & Ulcers

What is Venous Insufficiency?

Venous insufficiency (also called chronic venous insufficiency or chronic venous disease) is a condition in which the leg veins are damaged, preventing normal blood flow to the heart.

In normal veins a series of specialized, one-way valves work together, opening to allow blood to flow upward and then closing to keep the blood from flowing back toward the feet. Venous insufficiency occurs when valves are damaged or not functioning properly. As the valves deteriorate, blood leaks or flows backward and pressure in the vein increases, stretching and dilating the vessel. Blood pools in the veins of the lower legs, increasing the blood pressure in the legs and causing chronic inflammation in the veins.

What are Venous Ulcers?

People with long-term, untreated venous insufficiency sometimes develop open sores in the skin called venous ulcers. Ulcerations develop in areas where blood collects and pools, as swelling there interferes with the movement of oxygen and nutrients through tissues. Over time a visible ulcer develops on the skin. Venous ulcers usually appear just above the ankle on the inside of the leg. If they are not treated, they can become quickly infected or even gangrenous.

At NewYork-Presbyterian, our vascular specialists provide advanced and comprehensive care for the diagnosis and treatment of venous insufficiency and venous ulcers. Our two dedicated vein programs offer the highest level of multidisciplinary and comprehensive care for patients with a full range of vein disorders and diseases. With the latest technologies and the vast resources available at our two renowned medical centers--NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian/Weill Cornell Medical Center--our experts are here to provide the best possible care for your vascular health and well-being.

Signs & Symptoms

Symptoms of venous insufficiency may include:

Pain while walking
Edema (swelling) of the legs, ankles or feet
Varicose veins
Leg ulcers
Itching (pruritis)
Hyperpigmentation (dark discoloration of the skin)
Skin abnormalities including eczema, thickening, increased risk of infection, and inflammation

Risk Factors

Risk factors for venous insufficiency include the same factors that predispose people to spider veins and varicose veins:

A history of blood clots
Family history of varicose veins
Hormonal factors
Advancing age
Being overweight or obese
Prolonged standing
Prolonged sitting with legs crossed
Wearing tight undergarments or clothes
A history of blood clots
Injury to the veins

Venous insufficiency may also be caused by:

Damage to the valves in the veins from injury
Clots in the veins
Deep vein thrombosis (DVT)
Phlebitis (inflammation of a superficial vein)
Inherited clotting disorders

Diagnosis & Treatment

Doctors use an imaging test called a duplex ultrasound to determine if there is structural damage in the veins. Treatments for venous insufficiency are aimed at reducing swelling and improving the return of blood to the heart. Although venous insufficiency tends to get worse over time, early treatment can ease discomfort and prevent the condition from progressing.

Conservative Therapy

Conservative therapy for venous insufficiency may include the following:

Elevating the legs (above the heart) when not standing and exercising, which increases circulation
Compression stockings can relieve symptoms and improve quality of life
Lifestyle changes such as getting regular exercise and losing excess weight
If the patient has a history of deep vein thrombosis, blood thinners are often necessary as they prevent more clots from forming

Minimally invasive techniques

When conservative methods are not effective in managing venous insufficiency, minimally invasive techniques may improve symptoms in certain patients, including:

Vein radiofrequency ablation (RFA) - A catheter delivers microwave radiation to collapse and seal the vein shut
Endovenous laser ablation treatment (EVLT) - A catheter containing a tiny fiber optic probe is guided to the affected vein. The probe then transmits laser energy to the vein, causing it to close and eventually be reabsorbed by the body.
Catheter-based procedure - "Recanalizes," or opens up, chronically occluded veins through a combination of balloon angioplasty and stents

Traditional surgery

Doctors may sometimes perform a type of surgery called debridement to remove any non-living tissue from a wound or ulcer to promote its healing. During debridement, vascular specialists surgically remove all non-viable, infected tissue and bone from a non-healing ulcer. This process activates blood components called platelets and growth factors, which both promote healing. Doctors often perform debridement if a patient with a venous ulcer shows signs of infection including fever, elevated white blood count, and persistent or increased drainage.

Prevention

You can lower your risk of venous insufficiency and other vein problems by making lifestyle changes, including:

Avoiding smoking
Avoiding wearing restrictive clothing like tight girdles or belts
Don't sit or stand for too long at a time
Eat a heart-healthy diet
Exercise regularly
Maintain a healthy weight

Why Choose Us

Expertise in vascular care

NewYork-Presbyterian is a leader in the field of vascular care, with a long tradition of expertise, innovation, and leadership. Our vascular specialists are board certified in vascular or endovascular medicine, cardiovascular disease, and interventional cardiology. They have expertise in diagnosing and treating abnormalities of the vascular/circulation system, including venous insufficiency, offering the highest level of specialized care and advanced therapies. Our vascular specialists are internationally known for the treatment of these conditions using minimally invasive therapies.

Two dedicated vein programs

Our vein specialists are experts in the full range of treatments, including the most serious forms of vein disease such as chronic venous insufficiency and ulcers. NewYork-Presbyterian has two dedicated vein programs:

The Weill Cornell Medicine Comprehensive Vein Program is dedicated to the diagnosis and treatment of varicose, spider veins, and other venous disorders, providing personalized and specialized care within a state-of-the-art academic medical center.
At NewYork-Presbyterian/Columbia University Irving Medical Center, the Columbia Vein Program offers expertise to treat a full range of vein disorders and diseases, from cosmetic concerns to the most serious health emergencies.

Individualized and holistic care

At NewYork-Presbyterian, our vascular specialists offer individualized and holistic care, tailoring your treatment to your medical history, lifestyle, and wellness goals. Our goal is to understand your condition and then treat it in a way that improves your lifestyle and prevents future vascular problems. We work closely with our patients and referring physicians to coordinate a personalized treatment plan for every patient. We are especially skilled in diagnostic imaging, vascular medicine, and minimally invasive procedures that allow for shorter and less painful recovery times.

Multidisciplinary team approach

Vascular conditions can affect many areas of the body and may require input from other specialists. Our physicians collaborate with other world-renowned experts at NewYork-Presbyterian, ensuring that you receive the care you need. Your healthcare team may include vascular and endovascular specialists, surgeons, cardiologists, and other specialists.

Propelling the field through research

At NewYork-Presbyterian, our vascular specialists have experience with even the most complex vascular conditions. Our patient volume allows us to conduct clinical trials of all the newest vein therapies. In fact, the most advanced therapies are often available at our program before other centers in the country, and at times, the world. We continue to drive research into innovative and groundbreaking potential treatments.