What are venous insufficiency and its symptoms?

What is chronic venous insufficiency?

Chronic Venous Insufficiency, known by its acronym as CVI, is the inability of the veins to carry out the adequate return of blood to the heart, which causes the accumulation of blood in the legs, giving rise to different symptoms and problems.

Veins and arteries play a fundamental role in the proper functioning of our circulatory system since they are responsible for transporting blood from the heart to the entire body in two directions: from the organ to the different parts of the body -arteries-, and vice versa – veins-. The walls of the veins have tiny valves that open and close, and they serve to help control the pressure and flow of blood, facilitating its proper return to the heart.

In the case of the legs, there are basically two systems that allow the blood to overcome the force of gravity and return to the heart:

The valves actually exist in the walls of the veins. They only have a unidirectional upward movement towards the heart, which allows flow.

The second system is known as the muscle pump. The veins of the lower extremities are located between the muscles, therefore, with each step we take, a muscular contraction is produced that squeezes the veins and allows the upward flow of blood. This is the reason why it is advisable to walk or do physical exercise to promote circulation.

However, when the leg veins lose elasticity, they dilate and cause the aforementioned valves to be far apart from each other and not close properly. As a consequence, the blood, attracted by the force of gravity, accumulates in the legs, producing Chronic Venous Insufficiency (CVI), a disease whose main manifestations are varicose veins and tired legs. 

A sedentary lifestyle and lack of exercise can also predispose to the development of this pathology since the muscle pump is not activated.

What people are more likely to suffer from CVI?

CVI symptoms affect 30% of Spanish adults, according to data from the Spanish Chapter of Phlebology. Thus, in our country, about 15 million people suffer from it, of which it is estimated that 60% of cases are not diagnosed.

In general, it can be said that CVI is more frequent in women from 35 to 40 years of age, due to a hormonal predisposition, and its prevalence increases with pregnancies and with age (from 50 years of age, half of the population suffers). However, it is increasingly affecting younger patients, mainly because this pathology has a lot to do with lifestyle.

On many occasions, the patient himself underestimates this disease, but although it is true that it does not usually represent a serious health problem, it severely reduces the quality of personal and work life of the people who suffer from it and represents a health problem of the first magnitude. . In fact, according to data from the  Venous Association (ACTV), based on the Vein Consult Program study, more than 67% of patients who attend Primary Care have symptoms of chronic venous insufficiency

What are your causes?

There are several elements that can influence and be decisive in the appearance of this condition.

Age and genetic factors. Over the years, the elastic lining of the veins begins to weaken, thus increasing the chance that the veins will dilate. Likewise, the genetic factor directly influences the appearance of venous insufficiency. 

The pregnancy.  The hormones of this state cause the dilation of the veins. It is a necessary process that contributes to more blood reaching the uterus with the nutrients and oxygen necessary for the fetus to grow In addition, the uterus, as it grows, compresses the drainage veins of the pelvis, which makes it difficult for blood to empty from the legs and also causes the veins to dilate.  

Thus, around 40% of pregnant women suffer from varicose veins and other symptoms of CVI. However, these problems can disappear after childbirth, since the factors that caused them to cease.

Hormonal alterations.  Venous disease is more common in women due to hormonal influence. In addition, the aforementioned hormones in pregnancy are also found in contraceptive pills, so their consumption can increase venous permeability and dilation. In these cases, medical surveillance is necessary.

The overweight.  Excessive body weight increases pressure in the leg veins and aggravate their condition, which leads to a higher risk of CVI and associated complications.

Sedentary life and lack of exercise.  A sedentary lifestyle or inactivity have a direct influence since prolonged standing increases the pressure in the veins.

The occupational aspect.  In work activities in which many hours are spent standing or sitting, or that involve many long trips in short periods, the postures adopted with the legs and immobility hinder proper blood circulation, which can evolve into circulatory problems such as the IVC. 

It is therefore considered that people who work in these conditions are risk groups, as they are especially predisposed to developing CVI problems.

The heat. Usually, in summer the most frequent symptoms of CVI worsen. The heat causes the veins to dilate, so that, due to the effect of gravity, the blood accumulates in the legs, intensifying the feeling of heaviness and tiredness and exacerbating circulation problems. 

For this reason, avoid high temperatures in the leg areas and avoid the use of electric blankets, braziers, etc.

What symptoms does it produce?

CVI is a problem that does not go away over time, so the sooner it is diagnosed and treated, the better the chances of preventing associated complications and disease progression. For this reason, it is important to consult the pharmacist or the doctor if any of these first symptoms are observed:

Pain, tingling, heaviness, and usual tiredness in the legs.  These discomforts can be distinguished from others because they become more acute when at rest and with heat, and on the contrary, they decrease when lifting the legs and with cold.

Swelling of the lower legs and ankles.  Especially after prolonged periods of standing.

Night cramps.  They are also known as ‘restless legs syndrome. They can make it difficult to fall asleep and rest.

The sensation of heat, redness, dryness, and constant itching on the skin.  It is because the excess of retained blood causes an increase in temperature, so the skin becomes dehydrated and causes these effects.

Spider veins or telangiectasias.  They are dilatations of the capillaries, at a superficial level, which result in small reddish or violet lines with the appearance of a spider’s web. They are unsightly but painless and harmless.

Reticular varicose veins.  They are dilations of small veins that appear in a deeper area of ​​the skin than telangiectasias; in the reticular dermis.

Varicose veins or varicose veins.  They constitute the most prevalent and well-known clinical signs of CVI. They are dilations and elongations of the superficial veins, which occur when venous insufficiency is prolonged over time.

Skin signs.  Skin changes caused by poor circulation: dermatitis, eczema, hyperpigmentation, etc.