Venous Insufficiency

Venous insufficiency is a condition in which the veins do not efficiently return blood from the legs back to the heart. It occurs when the vein valves do not function properly, or when there is a chronic blockage in the veins. Both of these may occur after a Deep Vein Thrombosis (DVT).  Chronic venous insufficiency is one of the most common chronic conditions in the United States and worldwide.
 
Symptoms
Symptoms of chronic venous insufficiency may include:

• Varicose veins
• Swelling of the legs and pain in the extremities (dull aching, heaviness, or cramping)
• Discoloration of the legs (often a brown discoloration)
• Hard, thickened skin around the ankles
• Ulceration of the skin around the ankle

Diagnostic Tools
Chronic venous insufficiency is usually diagnosed by a history and physical examination. Duplex ultrasound is also commonly used for assessment of the veins. 

Treatment Options
There are several treatment options for chronic venous insufficiency. In most cases, the initial treatment is conservative and nonoperative. This typically includes:

• Compression garments or stockings
• Unna’s boots, which are gauze bandages coated with zinc oxide to create a semi-rigid "boot"

If conservative treatment is unsuccessful, then a more invasive surgical treatment is pursued. This treatment is focused toward eliminating or lessening the effects of the damaged valve function in the veins. Options may include:

• Sclerotherapy
• Vein stripping
• Valve replacement surgery
• Endoscopic perforator ligation
• Laser vein ablation