CHRONIC VENOUS INSUFFICIENCY

WHAT IS CHRONIC VENOUS INSUFFICIENCY?

Chronic venous insufficiency is when the network that circulates blood to the lower limbs is compromised due to the obstruction of blood flow or the backward flow of blood within the system, often resulting in venous hypertension (1,2,3).

Chronic venous insufficiency is classified as primary chronic venous insufficiency or secondary chronic venous insufficiency, based on the source of the venous incompetence. Prolonged weakening or abnormal shape of the valves within the superficial veins usually causes primary chronic venous insufficiency. Deep venous thrombosis causes the inflammation of the deeps veins, as well as scarring and adhesion of the valves in the deep veins leading to secondary chronic venous insufficiency (3).

RISK FACTORS FOR CHRONIC VENOUS INSUFFICIENCY

• Female gender
• May-Thurner syndrome
• Genetics
• Obesity
• Multiple pregnancies
• Venous injury
• Smoking
• Increasing age
• High blood pressure
• Prolonged standing
• Lack of physical activity (3,4,5,6)

SYMPTOMS OF CHRONIC VENOUS INSUFFICIENCY

• Hyperpigmentation
• Hardened, thickened skin
• Severe itching of the skin
• Venous ulcers
• Pain and cramping
• Pitting edema
• Fatigue
• Throbbing or tingling sensation
• Heaviness in lower extremity
• Varicose veins
• White scarring on lower leg or foot (3,4,7,8)

For more information on chronic venous insufficiency and diagnosis:  1. Talk to your doctor  2. Visit the Society of Vascular Surgery website  3. Visit the John Hopkins Medicine website 

CHRONIC VENOUS INSUFFICIENCY FACTS AND STATISTICS

Reports indicate that up to 17% of men and up to 40% of women in the general population of the United States of America, experience chronic venous insufficiency. Estimates also show that almost 150,000 new cases of chronic venous insufficiency are reported each year, costing the United States healthcare system nearly $500 million in care and treatment (3).

A 2017 publication estimated that more than 30 million adults in the United States have some form of chronic venous disease, and over 20,000 persons per year are admitted to hospitals for venous ulcers (9).

MEDICAL TREATMENT OF CHRONIC VENOUS INSUFFICIENCY

Compression therapy

This treatment is done using graduated compression stockings, which exerts a pressure gradient from the ankle upward, that allows blood to flow up to the heart, instead of back down to the feet. This therapy can resolve venous hypertension, reduce inflammation in venous ulcers and improve lymphatic drainage (10,11,12).

However, adverse effects of compression therapy with graduated compression stockings include (10):

• Discomfort with poorly fitted stocking that can lead to necrosis
• Possible ischemia in patients with existing blood flow problems
• Skin irritation from stocking material
• Skin ulcers

Pharmacological Treatment

• Sulodexide: Used for its anti-inflammatory and antithrombotic effects.  Possible side-effects include gastric pain, vomiting, diarrhea, heartburn and dizziness (13,14,15)
• Micronised purified flavonoid fraction: Used for treating edema and lymphatic drainage.  Possible side-effects include gastrointestinal and autonomic problems (16).
• Calcium Dobesilate: Marketed as Doxium.  Possible side effects include fever, gastrointestinal problems, skin irritation, joint pain and agranulocytosis (a condition involving dangerously low white blood cell count) (17).

Surgical Treatment

Surgery is often the last line of treatment for chronic venous insufficiency, usually after other treatment options have failed to work. Surgery for chronic venous insufficiency includes varicose vein ligation, reconstructive deep venous surgery, removal of varicose veins just beneath the skin surface, perforator vein surgery (18,19). Some of these procedures are invasive and recovery is long with poor life quality during recovery (20).

NATURAL WAYS TO HELP SUPPORT HEALTHY VEINS

Practices to Help Support Healthy Veins:

• Balanced diet
• Exercise
• Stop smoking (3,4,5)

Natural Supplements That Help Support Healthy Veins:

• Butcher’s Broom (21,22,23)
• Horse Chestnut (24,25,26,27,28,29)
• Grape Seed Extract (30,31)
• Cayenne (32,33,34,35)
• Gingko Biloba (36,37)
• Chromium (38,39)
• Gotu Kola (40,41,42)
• Buckwheat Seed (43,44)
• Citrus Bioflavonoids (45,46)
• Hesperidin (47,48,49,50,51,52)
• Pycnogenol (48,53,54,55,56,57,58,59)

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