What is venous insufficiency?
Dysfunction of the veins, by which the veins in the legs are most often affected, is called venous weakness (in medical terminology, venous insufficiency).
Function of the veins
Once the arterial system has transported oxygenated blood and nutrients to the outermost parts of the body, the venous system transports the blood back to the heart. The veins in the legs in particular have to pump the blood upwards against gravity. This is done by the leg muscles that squeeze the veins together every time they contract (calf muscle pump). Like non-return valves, the venous valves prevent the blood from flowing back down into the legs and pooling there.
How venous insufficiency develops
If the venous valves no longer close tightly, the blood in the veins can flow back down and it becomes congested and pools in the lower parts of the legs. The vein walls capitulate against the higher pressure and the veins widen. The result of this is that the venous valves now close even less than they did before. Moreover, the distended veins eventually become visible as thin spider veins and the larger veins as convoluted, bluish varicose veins, many of which also protrude conspicuously under the skin. The blood that has pooled in the veins also leads to fluid leaking out into the surrounding tissues. Therefore, swollen legs and thick ankles are also a sign of venous insufficiency. If the disease continues to progress further, doctors call it chronic venous insufficiency (CVI).
Causes of venous insufficiency
The risk of developing venous insufficiency rises with increasing age, usually those over 50. Someone with a history of blood clots is also a higher risk. Women are far more often affected than men. The reasons for this are the different structure of female connective tissue and the female hormone estrogen. This is why venous insufficiency also develops more frequently during pregnancy, because the estrogen concentration is particularly high during this time. Hereditary predisposition is also a cause of venous insufficiency. In this case, several members of the family may suffer from the disease. Obesity and activities that require long periods of standing or sitting can also favor the onset of venous insufficiency.
What happens if venous insufficiency is not treated
Tips for everyday living to prevent venous insufficiency
- Avoid sitting or standing for long periods
- Go for regular walks
- Take the stairs, not the elevator
- Activate the legs’ muscle pump with sports such as swimming, cycling and power walking
- Strengthen your veins with vein exercises
- Alternating hot and cold showers strengthen the vascular system
- Make sure you drink enough water
- Keep your weight down
- Limit your use of high heels
- Wear medical compression stockings as soon as you notice the first signs of early venous insufficiency
Diminishing venous pressure
Venous pressure is a term that represents the average blood pressure within the venous compartment. Venous pressure diminishes continually from the ankle towards the heart. When standing still, venous pressure is generally 90 to 110 mmHg at the ankle. Accordingly, a person’s height is decisive for the resting venous pressure when standing. As we move around, the pressure reduces to about 20 mmHg as long as sufficiently good venous drainage is guaranteed. Several factors are important for venous return to the heart.
The action of the heart towards the periphery (retrograde force)
Suction caused by breathing
The muscle pump
The deep venous system is embedded in muscles. Due to this, every muscle contraction squeezes the veins to push the column of blood in them in the direction of the heart. When the muscle relaxes, the venous valves prevent the retrograde flow of blood towards the capillaries.
Venous inflammation (phlebitis)
Usually the superficial veins are affected (superficial phlebitis). The inflammation occurs often in connection with varicose veins in the veins of the legs, although the veins of the arms and, rarely, the veins of the face and neck can also be affected. As a rule, phlebitis is restricted locally and can sometimes be very painful. The affected segment of the vein is visible as a red, warm and often swollen area on the skin. Inflammation caused by bacteria may cause fever.
A specialist (phlebologist, angiologist, vascular surgeon, dermatologist) must be consulted immediately: blood clots (thromboses) may develop as a result of the venous inflammation. If a deep leg vein is inflamed, this may cause a thrombosis that is also called deep vein thrombosis or phlebothrombosis.
Causes of venous inflammation
A slower blood flow is the most common cause of venous inflammation. It leads to inflammatory reactions on the weakened venous wall that is often predisposed by varicose veins. But venous inflammation can also occur where the vein is squeezed together over long periods by overly tight clothing or, for example, the edge of a hard chair. Another common cause are catheters that doctors place for infusions or giving medication and remain in the vein for several days. Venous inflammation can also be caused by an injury to the venous wall or by penetrating bacteria. It can also arise after operations and longer periods of confinement to a bed.
What happens if venous inflammation remains untreated?
Tips for everyday living that can prevent venous inflammation:
- Drink adequate amounts of fluids
- Avoid sitting or standing for long periods
- Do foot exercises to energize the venous pump
- Treat varicose veins
- Wear medical compression stockings every day if your legs already have varicose veins
- Stop smoking