Chronic Venous Hypertension

Other causes of chronic venous insufficiency include, but are not limited to, the following:

• High blood pressure in the leg veins over a long time, due to sitting or standing for prolonged periods
• Lack of exercise
• Smoking
• Deep vein thrombosis (a blood clot in a deep vein, usually in the calf or thigh)
• Phlebitis (swelling and inflammation of a superficial vein, usually in the legs)

Symptoms of chronic venous insufficiency may include:

• Swelling in legs and/or ankles
• Tight feeling calves or itchy painful legs
• Pain during walking that stops with rest
• Brown-colored skin, particularly near the ankles
• Varicose Veins
• Leg ulcers

The symptoms of chronic venous insufficiency may resemble other conditions. Consult your physician for a diagnosis.

In addition to a complete medical history and physical examination, diagnostic procedures for chronic venous insufficiency may include:

• Duplex ultrasound – a type of vascular ultrasound procedure done to assess blood flow and the structure of the leg veins. The term “duplex” refers to the fact that two modes of ultrasound are used – Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the vessel being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.
• Venogram – uses x-rays and intravenous (IV) contrast dye to visualize the veins. Contrast dye causes the blood vessels to appear opaque on the x-ray image, allowing the physician to visualize the blood vessels being evaluated.

Specific treatment will be determined by your physician based on:

• Your age, overall health and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures or therapies
• Your signs and symptoms
• Expectations for the course of the disease
• Your opinion or preference

Chronic venous insufficiency treatment may include:

• Measures to improve blood flow in the leg veins – Methods to help increase blood flow in the leg veins include elevating the legs to reduce pressure in the leg veins and compression stockings to apply pressure on the legs and help blood flow. Other methods include keeping the legs uncrossed when sitting and regular exercise.
• Medications – Several types of medications may be used to treat chronic venous insufficiency. Diuretics (medications used to draw excess fluid from the body through the kidneys) may be used to reduce swelling. Pentoxifylline, which improves the flow of blood through the vessels, may be used in combination with compression therapy to help heal leg ulcers. Anticoagulation therapy (blood thinning medication) may be recommended for those persons who have recurring problems with the veins in their legs.
• Sclerotherapy – For patients whose condition is more advanced, sclerotherapy may be prescribed. This involves injecting a chemical into the affected veins. The chemical causes scarring in the veins so that they can no longer carry blood Blood then returns to the heart through other veins and the body absorbs the scarred veins.
• Surgery – Surgery is recommended in fewer than 10 percent of people with chronic venous insufficiency.

Surgical procedures that may be used to treat the condition include:

• Ligation – tying off an affected vein so that blood no longer flows through it. If the vein and/or its valves are heavily damaged, the vein will be removed (“vein stripping”).
• Surgical Repair – A vein and/or valves may be surgically repaired, either through an open incision or with the use of a long catheter (hollow tube).
• Vein Transplant – transplanting a healthy vein from another body area and replacing the diseased vein with the healthy vein.
• Subfascial Endoscopic Perforator Surgery – A minimally-invasive procedure performed with an endoscope ( a small, flexible tube with a light and a lens on the end). The perforator veins (veins found in the calf area) are clipped and tied off. This allows blood to drain into healthy veins and improves ulcer healing.