Encompass Healthcare and Wound Medicine

Venous Insufficiency

Understanding Venous Insufficiency

Chronic venous insufficiency refers to a long-term condition where the veins inside the legs have lost their ability to move blood back up to the heart from the legs. In other words, the vein walls have weakened to the point where there are insufficient muscular pumps to sequentially squeeze fluids up the leg and against gravity; and/or the tiny valves inside the leg veins do not work sufficiently enough to keep blood from seeping back down past the valves to pool in the lower legs.

THE MECHANICS OF VENOUS INSUFFICIENCY

The circulation system in our legs is very much like the branches in a tree (Figure 2) that spread out into smaller and smaller branches all the way out to the end of the leaves.

Figure 3: The tiny "veins" in a leaf correspond to the capillaries in humans that extend outward to our skin.

Figure 3: The tiny “veins” in a leaf correspond to the capillaries in humans that extend outward to our skin.

The energy from the sun gets absorbed through the leaf surface and into The tiny “capillaries” in the leaves. Then, it travels inward through larger “veins” back to the main root system. (Figure 3.)

Figure 4: Spider veins are superficial, but they can indicate a larger venous insufficiency issue.

Figure 4: Spider veins are superficial, but they can indicate a larger venous insufficiency issue.

It’s the same transport concept inside the human body as tiny capillaries near the skin feed larger vessels on their way back up to the heart. When the inside walls of capillaries become weakened due to a number of factors including heredity, blood pressures and gravity, they can become warped and twisted, taking on the appearance of a spider web from which they get their name. (Figure 4). Spider veins can be a local occurrence in the body or they can be evidence of a larger venous insufficiency issue.

Figure 5: A varicose leg vein.

Figure 5: A varicose leg vein.

When the valves inside the leg veins malfunction to the point where blood seeps back down toward the feet, the walls inside the vein stretch and become misshaped. We call these veins “varicose veins” (Figure 5).

Figure 6. Left: Normal valves allow blood to flow upward and block backflow (reflux). Right: Faulty valves allow blood to flow back down to pool in the lower legs and feet.

Figure 6. Left: Normal valves allow blood to flow upward and block backflow (reflux). Right: Faulty valves allow blood to flow back down to pool in the lower legs and feet.

Peripheral artery disease can include venous insufficiency, leading to venous stasis ulcers, successfully treated at Encompass HealthCare.

Peripheral artery disease can include venous insufficiency, leading to venous stasis ulcers, successfully treated at Encompass HealthCare.

Chronic Venous Insufficiency (CVI) presents in several ways.

Figure 1: Chronic Venous Insufficiency (CVI) presents in several ways.

The risk factors for venous insufficiency include:

  • Age over 50
  • Varicose veins
  • Being tall
  • Inactivity
  • Muscle weakness
  • A previous injury to the legs
  • Family history of venous insufficiency
  • History of deep vein thrombosis (blood clots) in the legs
  • Obesity
  • Pregnancy
  • Smoking
  • Being female
  • Sitting or standing for long periods

The symptoms of venous insufficiency include:

    • A dull aching, heaviness, burning, throbbing or cramping in the legs
    • Leg pain that gets worse when standing
    • Pain that gets better when legs are raised
    • Flaking, itching or tingling on the legs or feet
    • Swelling of the legs
    • Redness of the legs and ankles
    • Skin color changes around the ankles
    • Varicose veins on the skin surface
    • Thickening and hardening of the skin on the legs and ankles
    • Ulcers on the legs and ankles
    • A wound that is slow to heal on the legs or ankle

Leg and ankle ulcers (sometimes called venous stasis ulcers) are very common due to venous insufficiency. For more detailed information on venous stasis ulcers click HERE.

Treatments for Venous Insufficiency

 

VENOUS ABLATION

MINIMALLY INVASIVE VENOUS ABLATION FOR CHRONIC VENOUS INSUFFICIENCY (CVI)

Venous ablation is the surgical procedure of shutting down one poorly performing vein in the leg so the body will return venous blood more efficiently through its healthier leg veins. At Encompass HealthCare and Wound Medicine, we perform two types of venous ablation: Radiofrequency Ablation and ClariVein, a non-thermal vein ablation system. Both methods represent significant advances in medicine, as they are far less invasive with fewer complications and dramatically improved healing rates when compared to outdated procedures like vein stripping or surgical vein removal. For more detailed information on venous ablation, click HERE.

 

COMPRESSION THERAPY

Traditional compression stockings.

Traditional compression stockings.

Velcro compression wrap

Velcro compression wrap

The goal in treating chronic venous insufficiency is to improve the flow of blood back up to the heart. For mild cases and for maintenance after better blood flow is achieved, we want to support the weakened valves inside the veins and deter fluids from leaking out of the veins through compression stockings or the newer and easier-to-apply Velcro compression wraps.

Both of these products are designed to provide higher compression around the foot and ankle with decreased compression moving up the leg. With the Velcro compression wraps, the patient has a bit more control over the amount of pressure applied.

Compression Therapy Using Pneumatic Pumps

Pneumatic Compression Pumps: Compartments inside a durable “sleeve” fill and deflate with air sequentially.

Venopneumatic Compression Pumps: These compression pumps automatically inflate and deflate sequentially to force fluids back into the veins and then move them up from the lower extremities.

With venopneumatic compression pumps, patients place their legs in special sleeves that are attached to a small, portable pump. The sleeves have built-in compartments that fill with air and then deflate sequentially to push fluids up the legs.

At Encompass HealthCare, we recommend patients devote 1.5 hours twice per day for venopneumatic compression therapy. With this frequency, patients usually experience the best control over their venous insufficiency.

MANUAL LYMPHATIC DRAINAGE

Manual lymphatic drainage (MLD) is a type of gentle massage which is intended to encourage the natural drainage of the lymph, which carries waste products away from the tissues back toward the heart. This is a primary treatment for primary lymphedema or lymphedema due to venous insufficiency.

Manual lymphatic drainage helps the lymph fluid return back into its native vein or lymph vessels, using a specific amount of pressure and rhythmic circular movements to stimulate lymph flow. For more detailed information on Manual Lymphatic Drainage (MLD,) please click HERE.

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