For more than 30 million adults in the US, swollen feet, sore calves and skin changes are more than just a daily nuisance. These are signs of chronic venous insufficiency, a condition in which the veins in the legs can’t effectively return blood to the heart — and one that made headlines this year after it was announced that President Donald Trump had been diagnosed with it.
If left untreated, chronic venous insufficiency can develop into painful ulcers and limit mobility, yet many patients delay care because symptoms may seem like a normal part of aging. Doctors stress that early recognition and treatment can improve quality of life and prevent complications.
The AMA’s What Doctors Wish Patients Knew™ series gives doctors a platform to share what they want patients to understand about today’s health care headlines.
In this installment, Charles C. Leithhead, MDvascular surgeon at Ochsner Health, discusses what patients should know about chronic venous insufficiency.
Ochsner Health is part of it AMA Health System Member Programwhich provides business solutions to equip leadership, physicians and care teams with resources to help advance the future of medicine.
Damaged veins prevent blood from returning to the heart
“Chronic venous insufficiency is the weakening of the venous valves that prevent blood from returning to the heart,” Dr. Leithead said. “This can lead to increased pressure in the legs due to damaged venous valves, which do not close completely when pumping blood back to the heart.”
This increased pressure can lead to swelling, varicose veins and varicose veins,” he added. “In the worst case scenario, the skin is pressed so much that it can actually open up into a sore or wound.”
Spider veins are often a first sign
“Due to weakness of the venous valve, the blood does not fully return to the heart,” explained Dr. Leithead. “This increased pressure in the leg can cause varicose veins, which are enlarged veins – branches of our superficial veins.”
“Spider veins are often the first sign of venous insufficiency. When these small spider veins become overwhelmed with pressure, branches or varicose veins develop,” he said. “Thus, varicose veins are a cause of venous insufficiency.”
“Among the signs of chronic venous insufficiency is heaviness or pain in the legs at the end of the day, especially for those with prolonged standing or desk work,” Dr Leithead said. “Swelling in the foot and ankle, as well as itching, which can be associated with restless legs syndrome, are also signs.”
“If you have varicose veins, varicose veins or a long-term non-healing wound – most commonly in the ankle area – these are also signs,” he added. “Discoloration, such as a dark purple on the lower leg or a copper-gold skin tone, is another indicator.”
Pay attention to your family history
“You may be at higher risk if you have a family history of chronic venous insufficiency in a relative or a parent,” Dr. Leithead said. “If both parents have chronic venous insufficiency, you can have up to an 80% risk of developing it. One parent represents a 50% risk.
Meanwhile, “women are at higher risk because of certain hormones, previous pregnancies and blood clots,” she said. “Other risk factors include people who have had blood clots, people with prolonged standing or sitting at work, a sedentary lifestyle, a high-sodium diet and obesity.”
What is needed to make a diagnosis?
“Chronic venous insufficiency is diagnosed based on a patient’s history,” Dr. Leithead said. “A venous insufficiency ultrasound is also used to assess how quickly the valves can pump blood back into the heart and to assess for blood clots.”
“It’s important to seek medical help when you have signs or symptoms,” he stressed. “Even if it’s mild swelling or a mild heaviness, it’s important to evaluate it to avoid worsening symptoms, as well as varicose veins or varicose veins.”
Consider treating varicose veins
“While treatment for varicose veins is not always necessary, reducing the pressure is vital,” Dr Leithead said. “Medical treatment involves medical-grade, graduated compression stockings with approximately 20 to 30 millimeters of mercury. These should be worn in the morning and removed at night.”
“Exercising throughout the week, pumping your calf muscles with socks, elevating your legs when sitting, reducing your sodium intake and watching your water intake,” he added, “can all help prevent the development of varicose veins.”
In addition, “varicose veins can bleed, develop clots, become red, become infected and cause severe pain if they develop an inflammation called thrombophlebitis,” Dr. Leithead said. “It is not wise to treat every varicocele, but it benefits the patient to prevent progression and the development of inflammation, clots or bleeding.”
Medical treatment is very effective
“Medical treatment may be somewhat limited in a warmer climate or in certain closets, but it is very effective,” Dr. Leithead said. “If the varicose veins hurt, burn, or itch, heat can be applied with a warm compress or heating pad, and an anti-inflammatory medication can be taken as needed.”
“If medical treatment does not resolve symptoms or improve the patient’s quality of life, we can treat weak venous valves with a minimally invasive procedure called laser ablation,” he said. “There’s little to no downtime—you’re in and out of the clinic.”
“We use the laser to close the weak venous valves to prevent the pressure from supplying the spider veins of the lower leg or varicose veins,” explained Dr. Leithead. “Once that pressure is treated or the laser ablation is complete, or if you have normal veins but still have varicose veins and varicose veins, we can remove the varicose veins with a procedure called phlebectomy.
“This includes small needle pricks in the office,” he added. “We can also inject the spider veins with a drug approved by the Food and Drug Administration.”
Complications can occur without treatment
“If you don’t treat chronic venous insufficiency, you can develop spider veins, which can become painful, and varicose veins can also become painful, bleed or increase in size and number,” Dr. Leithead said. “You may also experience heaviness, pain and discoloration in the legs that prevent you from doing things you enjoy, reducing your quality of life.”
“In the worst case scenario, the discoloration on the feet can progress, the integrity of the skin can be reduced and a wound can develop, which can be a risk for limb loss or infection,” he said. “Early treatment will prevent this progression, take care of the pressure, remove the varicose veins and eliminate the varicose veins.”
Reduce sodium intake
“Making appropriate lifestyle changes has an important association with prevention, because of the pressure build-up during the day with gravity and sodium pulling fluid into our legs,” Dr Leithead said. “It’s not just the salt you put in your food, it’s the salt that’s already in the food.”
“We know that the American diet is very high in sodium despite added salt,” he said. “It’s important at the grocery store to look at the labels. Try to ideally stay under 1,500 milligrams of sodium per day by mixing up your portion sizes throughout the day.”
“Some foods are high in sodium, such as canned foods and frozen foods,” Dr. Leithead said. “So it’s always best to eat fresh.”
Exercise and hydration
“In chronic venous insufficiency, if you sit at your desk all day, you can put your feet up,” Dr. Leithead said. “In addition, it’s important to exercise weekly — usually about two to three times a week, without breaking a sweat.”
“The amount of water we drink is also important,” he said. “We recommend 64 ounces of water per day. However, excessive water intake, unless it’s a medical condition or dehydration, could add extra fluid to the foot.”
“When you exercise, calf compression helps pump or compress the veins in the calves and pump fluid into the legs,” explained Dr. Leithead. “Lack of exercise or movement can put pressure on the legs.”
Get prescription compression stockings
“On long days, if you’re on your feet for work or travel, you can wear compression socks,” Dr. Leithead said. “It’s best to get a prescription because they have different pressures going up the leg, which helps draw fluid out of the leg better than over-the-counter options.”
“Any compression is better than no compression,” he said. “The most common reason people wear them on flights is to prevent deep vein thrombosis, or a blood clot from cutting blood off the legs while sitting still. Whether it’s a flight, the office, or a car ride, it’s important to get up and walk around every one to one and a half hours to get fluid out of the legs.”
It may not just be old age
“If you have signs or symptoms of chronic venous insufficiency, it may not just be old age or arthritis,” Dr. Leithead said. “You may have weak venous valves and there is a good solution to improve your quality of life.
“You should look for a vascular doctor who has training in vein treatments at a comprehensive vein clinic or vein center,” he added.
