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Venous Insufficiency and Venous Ulcers

What are Venous Insufficiency and Venous Ulcers?

The vascular system can be described as a vast network of blood vessels leading to and from the heart. Nutrient- and oxygen-rich blood is transported throughout the body by the arteries, and is then carried back to the heart via the veins. While blood-flow through arteries is assisted by force created from the pumping of the heart, this force is much lower in the veins. Additionally, particularly in the legs, blood-flow in the veins must progress upwards, against the force of gravity. To overcome these difficulties, the veins contain a series of specialized one-way valves that open to allow the blood to flow upwards, and then shut to keep the blood from flowing back downwards towards the feet.

Venous insufficiency is a chronic condition in which blood does not flow normally through the veins from the feet back up towards the heart. Venous insufficiency occurs because the valves are damaged, allowing blood to leak backwards and stagnate (pool) in the veins of the lower legs. This in turn increases the blood pressure in the legs and causes chronic inflammation in the veins. Venous insufficiency occurs most frequently in the legs, where blood must consistently fight the force of gravity in traveling back to the heart.

Venous ulcers are a not infrequent outcome of long-term untreated venous insufficiency. The area where the blood pools has a tendency to ulcerate first the blood vessels break down, and then the surrounding tissue can break down as well. Eventually, a visible ulcer develops on the skin. These ulcers appear mostly on the lower legs, just below the ankle. Left untreated, they also have a capacity to become quickly infected or even gangrenous.

The incidence of venous insufficiency rises with age. Other risk factors for venous insufficiency are family history of vascular problems and lifestyle. Specifically, people with a sedentary lifestyle or who have jobs that involve spending long hours on their feet have a higher risk of developing the condition. Venous insufficiency can also be caused by a partial blockage of the veins, for example by a blood clot this condition is called Deep Vein Thrombosis.

How are Venous Insufficiency and Venous Ulcers Diagnosed?

The most common early symptom of venous insufficiency is chronically swollen ankles. Swelling also occurs in the feet and calves, and is accompanied by a dull aching, cramping, or feeling of heaviness in the legs and feet that becomes worse after prolonged standing.

As it progresses, venous insufficiency also leads to patches of brown discoloration and deterioration (flaking or hardening) of the skin around the ankles. The eventual outcome, if untreated, is the development of venous ulcers.

An imaging test using duplex ultrasound will help to determine whether there is structural damage in the vein.

What Treatment Options are Available?

Treatment of venous insufficiency is directed at reducing and managing leg swelling and improving return of the blood upwards towards the heart. Elevation of the legs (above the heart) when not standing helps the blood return to the heart, decreases blood pooling, and ultimately decreases swelling. Exercise, which stimulates the calf muscles and increases circulation, may also be recommended.

The most common treatment for venous insufficiency involves wearing "compression stockings," special stockings that apply steady pressure to the leg, thereby increasing circulation. Compression stockings can prevent much of the swelling caused by the disorder. Medication may be prescribed to thin the blood, particularly in patients with a high risk of blood clots.

In the event that a venous ulcer is present, the goals are to prevent infection and promote healing of the wound. Many novel treatments are available to help heal venous ulcers, including the application of substances called growth factors and the use of gene therapy.

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