Dear Doctor: I was recently diagnosed with chronic venous insufficiency in both legs. What is it, and why does it happen? What does it mean for my health?
Dear Reader: One of the tradeoffs of the evolution of upright posture in humans is that at some point, the various fluids that circulate throughout our bodies face an uphill climb. This is particularly true of our blood, which gets pumped from a location high up in the body. Not only does it need to reach all of our tissues, but it has to complete a timely round trip back to the heart.
A branching network of arteries carry oxygenated, nutrient-rich blood away from the pumping chambers of the heart and out to the tissues via the capillaries. A similar network of veins return oxygen-poor blood and waste products back to the heart.
When you have chronic venous insufficiency, or CVI, it means that the deeper veins in your legs aren’t working efficiently to return the blood to the heart. This happens when the walls of the veins become weakened, and when the tiny one-way valves within the veins no longer function properly. These valves are an ingenious solution to the gravity fighting against the blood moving up from your legs back to the heart.
Working in concert with our muscles and with the smooth and elastic vein walls, these valves use a pair of opposing flaps to prevent the rising blood from ebbing backward between heartbeats. With CVI, the blood fails to make a consistent upward climb and pools in the veins. Blood pressure within the veins rises, which can damage both the veins and the valves.
Risk factors for CVI include age, family history, prolonged inactivity, pregnancy, obesity and being quite tall. CVI may also occur in people who have experienced deep vein thrombosis, which is a blood clot in the deep veins of the leg. Symptoms include swelling in the lower leg and ankle -- particularly after prolonged standing -- as well as aching, throbbing or tiredness in the legs. Skin on the legs and feet may itch, flake or appear leathery, and new varicose veins may emerge. The condition becomes more common after age 50, and is seen more often in women than in men.
Chronic venous insufficiency is not life-threatening; if ignored, however, it can lead to serious complications. These include leg ulcers, pulmonary embolism, deep vein thrombosis and secondary lymphedema, which is swelling in the tissues due to damage to the lymphatic system.
Depending on the severity of your particular condition -- there are varying degrees of CVI -- your doctor will outline strategies for you to follow. These can include being advised to lose weight, wear compression stockings, exercise regularly, elevate the legs, avoid prolonged standing and maintain skin care. Some patients benefit from nonsurgical treatments that use injected solutions or laser therapy to collapse certain smaller vessels.
It’s important for your health that you follow your doctors’ recommendations and make managing CVI part of your daily routine.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
