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