What is venous insufficiency?

Venous insufficiency occurs when the normal flow of blood from the superficial veins to the heart via the perforating and deep veins in the lower limbs is impaired, resulting in chronic venous congestion. It can be classified as superficial vein insufficiency, perforating vein insufficiency, and deep vein insufficiency.

Who gets venous insufficiency?

Venous insufficiency is common, affecting all races and both sexes. The prevalence of chronic venous insufficiency has been reported to be as high as 50% in some populations. A study from San Diego found ethnic whites had a higher rate of chronic venous insufficiency compared to Hispanics, African Americans, and Asians. Although varicose veins are more common in females, some studies have shown chronic venous insufficiency has a male predominance. The prevalence of venous insufficiency increases with age.

Risk factors for the development of venous insufficiency include:

  • Family history of venous insufficiency
  • Lifestyle factors, such as prolonged standing or sitting, sedentary lifestyle, dependent legs, or smoking
  • Obesity
  • Pregnancy
  • Venous thrombosis
  • Lower leg trauma
  • Anatomical variations of the blood vessels of the lower legs.

What causes venous insufficiency?

The venous system in the lower legs consists of a low-pressure superficial network connected by perforating veins to a high-pressure deep network. Venous blood flows from the superficial veins to the deep veins, then against gravity to the heart pumped by the calf muscles. Backflow is prevented by valves.

Chronic venous insufficiency can be caused by:

Venous disease

  • Incompetent valves in the superficial, perforating, and/or deep veins
  • External compression
  • Deep venous obstruction
  • Previous deep vein thrombosis.

Impaired calf muscle pump

  • Immobility
  • Paralysis
  • Joint disease
  • Obesity
  • Femoral vein compression.

What are the clinical features of chronic venous insufficiency?

Venous insufficiency can be asymptomatic. Superficial venous insufficiency may cause burning, swelling, throbbing, aching, cramping, or heaviness in the leg. Pain is typical of deep venous insufficiency. Symptoms improve with leg elevation.

Clinical signs of chronic venous insufficiency include:

  • Pitting edema around the ankle, worse by the end of the day
  • Telangiectasia (corona phlebectatica paraplantaris) — abnormal blood vessels visible on the inner aspect of the ankle
  • Pigmentation can be pinpoint, patchy, or extensive red-brown due to hemosiderin deposits after red cell extravasation
  • Pressure erythema — groups of small telangiectasias close to incompetent valves.

How do clinical features vary in differing types of skin?

A study of chronic venous insufficiency in Thai patients in comparison with ethnic white patients, reported an earlier onset of disease, less common association with a past history of deep venous thrombosis, less symptoms, less visible varicosities, and more common deep vein reflux.

Information Source: DermNet NZ: https://dermnetnz.org/topics/venous-insufficiency/