Venous insufficiency: definition, factors and treatment

What is venous insufficiency?

Chronic venous insufficiency (CVI) is a progressive disease that affects the venous system of the lower limbs and is characterised by venous hypertension, poor venous return and a series of symptoms, including pain, swelling, skin changes and ulcerations in the most advanced stages of venous insufficiency.
 

What are the risk factors for venous insufficiency?

Risk factors for venous insufficiency include age, gender, pregnancy (which can compress the veins and worsen symptoms), family history, obesity or being overweight (which increase pressure in the legs and slow venous return), lack of physical activity, smoking and a history of phlebitis.

Heat also dilates the veins and exacerbates the sensation of heavy legs, as does prolonged sitting or standing, which hampers venous return.

It's important to treat these circulation problems early to avoid suffering from them as we get older. The first person to contact is your GP, who can then refer you to an angiologist or phlebologist if necessary. To help you know when to seek medical advice, please see our article.

What is the cause of venous insufficiency?

CVI is the consequence of venous hypertension due to a lack of tone in the veins and insufficient venous valves, which normally ensure that blood does not flow back into the veins^(2,7).

This insufficiency of the venous valves leads to venous reflux and a reduction in the return of blood from the veins to the heart^(2,7).

This poor venous return is at the root of the sensation of heavy legs, often accompanied by tingling, swelling and the other complications mentioned above (varicose veins, skin changes, ulcerations, etc.). Hypoxia and inflammation are also at the root of these complications^(2,7).

The lack of tone in the veins and stagnation of blood in the legs leads to enlargement of the veins, forming varicosities which can vary in size and colour, from blue to black, and are accompanied by pain of varying intensity^(2,7).
 

What are the possible complications of venous insufficiency?

Chronic venous insufficiency can lead to various complications.

First of all, venous insufficiency can become chronic, with complications that can be progressive: oedema, skin changes and the appearance of venous ulcers in the most advanced cases, which are difficult to treat^(1,7,10).

Chronic venous insufficiency can also lead to serious complications, such as thrombo-embolic events. Venous thrombosis, also known as phlebitis, can develop⁽¹⁰⁾ as a result of poor venous return and the accumulation of blood in the lower limbs, blood clots can form in a superficial or deep vein 

Venous thrombosis can even be complicated by pulmonary embolism (if a clot forms in a deep vein, breaks loose and travels from the lower limbs to the lungs), a medical emergency that causes twelve thousand deaths every year in France⁽⁹⁾. 

Another complication is post-thrombotic syndrome. Post-thrombotic syndrome (PTS) is a chronic complication that occurs after deep vein thrombosis (DVT)⁽¹¹⁾. It develops in 20-50% of patients and has signs and symptoms in common with chronic venous insufficiency: pain, a feeling of heaviness in the legs, swelling (oedema) and altered skin, sometimes with ulcerations^(12,13).
 

How is venous insufficiency treated? 

All patients with signs and/or symptoms of CVI should first be treated conservatively. The use of compression stockings is the mainstay of this conservative management. However, risk modification such as weight reduction in obese patients, regular exercise such as walking, and smoking cessation should also be encouraged in patients. 

Other treatment methods exist to manage CVI. There are drug treatments and, in some cases, surgical interventions⁽³⁾.
If you have varicose or spider veins, or following surgery, your doctor may recommend the use of compression stockings. These are particularly beneficial for⁽¹⁵⁾: 

• Reduce pain and the feeling of heaviness in the legs, 
• Reduce swelling in the lower limbs, 
• Preventing the onset of venous thrombosis, especially during periods of prolonged inactivity following surgery or trauma,
• Avoid complications of thrombosis, such as post-thrombotic syndrome (pain and swelling in the leg). 

In the early stages (C0 and C1), there is no evidence that venous compression can slow the progression of the disease. However, from stage C2 onwards, characterised by the appearance of varicose veins of 3 mm or more, venous compression becomes the treatment of choice. The strongest clinical evidence is for the treatment of open venous ulcers at stage C6^(16,17).

Compression therapy is therefore an essential solution for combating venous insufficiency⁽¹⁷⁾.