Chronic Venous Disease

Veins and Valves

Blood return from the legs occurs mainly through the deep veins. Within the veins, especially those of the legs, are valves. Venous valves are bicuspid (two) flap like structures made of elastic tissue. The valves function to keep blood moving in one direction.

Venous Blood Flow

The flow of blood in the venous system is complex for several reasons:

  • Low pressure within the veins
  • Flow rates that vary from high (during muscle contraction) to almost no flow during quiet standing or sitting positions
  • Gravity
  • Collapsible nature of the venous wall
  • Presence of valves
  • Large volume of blood carried in the veins

Once the blood has passed from the arteries through the capillaries, it is flowing at a slower rate because little pressure remains to move the blood along. Blood flow in the veins below the heart is helped back up to the heart by the muscle pump. The walls of the veins are thin and somewhat floppy. To compensate for this, many veins are located in the muscles. Movement of the leg squeezes the veins, which pushes the blood toward the heart. When the muscles contract, the blood within the veins is squeezed up the vein and the valves open. When the muscle is at rest, the valves close helping to prevent the backward flow of blood.

Healthy vs. Damaged Valves

Healthy legs have veins with smooth, elastic walls that are perfectly designed to adapt to the changes in pressure within a vein. Veins have valves that keep blood moving in one direction: back toward the heart. As the leg muscles are activated, the venous valves open to allow one-way flow in the direction of the heart. When the muscles relax, the valves close to stop any back-flow.

But if the walls of a vein have been damaged by varicosis or thrombosis, the vein may dilate and the valves fail to close properly. When valves fail to work properly, blood flows backward into the veins. This results in blood pooling, putting pressure on lower leg veins, which may cause even more valves to fail over time.

So when the body is upright, the blood being transported back to the heart may stagnate in the legs. The pressure in the superficial veins directly under the skin rises and the veins become swollen. Tired, aching legs are the most common early symptoms – particularly after prolonged standing. Later, fluid may collect in the feet and ankles causing them to swell. The skin above the ankles may become thin and discolored or even break to form a venous stasis ulcer.

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Chronic Venous Disease (CVD)

Venous disease is a chronic condition, meaning the symptoms can be life-long and can progress if not treated. There are several risk factors that can increase the possibility of someone developing a vein disorder.

CVD Risk Factors

One of the most common vein diseases is Chronic Venous Disease (CVD) causing valves in the veins to weaken over time. The disease is most common in women in their 40s and men in their 70s. CVD risk factors include:

  • Family history of Deep Vein Thrombosis (DVT)
  • Heart disease
  • History of leg trauma
  • Inactive lifestyle
  • Multiple pregnancies for women
  • Obesity
  • Old age
  • Prior cases of Deep Vein Thrombosis (DVT)
CVD Symptoms

Minor Symptoms

  • Itchy legs
  • Leg or ankle swelling
  • Changes in skin color, especially in lower leg

Moderate Symptoms

  • Aching or throbbing in legs
  • A heavy feeling in the legs
  • Leg cramps
  • Development of further skin changes in legs
  • Varicose veins
  • Swelling / tightness in the leg or calf muscle

Severe Symptoms

  • Pain
  • Skin pigment changes (red or bronze discoloration)
  • Dry scaly, itchy skin (eczema changes)
  • Edema
  • Dilated veins
  • Fibrosis and hardening of the skin of the lower legs
  • Lower leg ulcerations
Other types of vein disease

Deep Vein Thrombosis

One of the biggest risk factors of CVD is prior Deep Venous Thrombosis (DVT). A DVT is a blood clot in the deep venous system. It most commonly occurs in the deep veins of the legs, but can occur in other deep veins such as in the arms or pelvis as well. Risk factors for DVT include:

  • Age
  • Major Surgery
  • Major Trauma
  • Hospital stays over 3 days
  • Immobility or paralysis / paresis
  • Estrogen containing medications
  • Pregnancy
  • Chronic Medical Conditions (inflammatory bowel disease, lupus, coagulopathies)
  • Active cancer
  • Obesity
  • Previous Venous Thromboembolism (VTE)
  • Family history of VTE
  • Institutionalized living (nursing home, etc.)

 

Symptoms of Pulmonary Embolism

Vein diseases can lead to deep vein thrombosis (DVT). In turn, this can lead to a pulmonary embolism (PE), which is caused when a blood clot develops and travels to the lungs. There are several symptoms of pulmonary embolism, and you should seek immediate evaluation if you experience any of these symptoms:

  • Sudden feeling of shortness of breath
  • Chest pain that gets worse when taking deep breaths
  • Lightheadedness or dizziness
  • Sudden fainting
  • Increased heart rate
  • Coughing up blood

A pulmonary embolism can be fatal; therefore getting medical attention as soon as possible increases survival rates. If you have a condition impacting your veins, managing the condition can reduce your risk for developing further complications like DVT and pulmonary embolism.

Post-Thrombotic Syndrome

DVT can lead to a condition called Post-Thrombotic Syndrome (PTS), a chronic condition that can lead to permanent disability. PTS occurs in up to 50% of patients with a history of DVT. It occurs when the blood clot organizes around the fragile venous valves in the deep veins, damaging them permanently. This increases the pressure in the veins and can lead to permanently decreased quality of life. PTS symptoms include aching, heaviness, swelling, cramps, and skin changes. For some patients the symptoms are just bothersome. For others it negatively impacts their quality of life. More severe PTS can lead to leg swelling, further skin changes, and development of venous leg ulcers.

Compression hosiery worn daily for up to two years can both prevent development of PTS and alleviate its symptoms.

Managing Vein Disease

Vein diseases can be effectively managed in a variety of ways that not only relieve symptoms, but prevent them from worsening. Managing vein disease is all about improving blood flow in the affected area.

Doctors consider several factors when deciding on a management option, including your age, symptoms, ability to tolerate different management options, and the vein disease’s expected progression. Common solutions include:

  • Compression Therapy: Compression therapy involves using compression garments, like the ones manufactured by JOBST, to improve blood flow in the damaged area. Compression garments use gradient compression, which puts pressure on the extremities to improve blood flow and help you recover faster by putting a higher level of pressure at the bottom of the limb and gradually decreasing pressure further up the limb.
  • Medication: Your doctor may prescribe medication for you to take, often in combination with compression therapy. You may also be prescribed medication to help treat leg ulcers.
  • Sclerotherapy: In some cases, the best treatment is to stop the affected veins from being able to transport blood. Veins are injected with chemicals, which causes scarring and stops blood transport through those veins.
  • Surgery: In some cases, surgery may be required to directly change the way the blood flows in the body, and blood flow is directed away from damaged veins. Surgery is also used to repair, remove or transplant damaged veins.
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Marie-Josée Samson
JOBST® UltraSheer Aurora, cranberry

What is Gradient Compression?

JOBST® uses gradient compression in the garments we manufacture. Gradient compression has the greatest pressure at their base, and reduces pressure as the compression garment goes up the arm or leg. This helps encourage the movement of fluids, whether its blood circulation or lymph fluid circulation. The gentle pressure helps blood vessels and lymph vessels absorb fluids more easily, providing relief for tissues and reducing swelling.

Why Use Gradient Compression?

Gradient compression is one of the most effective ways to manage the swelling caused by lymphedema and venous disorders. JOBST compression garments help relieve pain and reduce swelling by preventing accumulation of swelling and helping counteract the tendency of the body to swell.

Stopping fluid buildup also helps reduce your risk of infection and helps encourage fluid flow back to your heart. Gradient compression not only helps relieve symptoms, but can also help reduce risk of further complications.

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Sources :
1. Eberhardt, R.T., Raffetto, J.D.. « Chronic venous insufficiency », Circulation, 2014, vol. 130, no 4, p. 333-346.
2. Nicolaides, A.N.. « Investigation of chronic venous insufficiency. A consensus statement », Circulation, 2014, vol. 102, no 20, p. e126-e163.
3. Kahn, S.R.. « How I treat postthrombotic syndrome », Blood, 2009, no 114, p. 4624–4631.
4. Baldwin, M.J., et collab. « Post-thrombotic syndrome: a clinical review », ,J Thromb Haemost., mai 2013, vol. 11, no 5, p. 795-805.
5. Heit, J. “The epidemiology of venous thromboembolism in the community », Arterioscler Thromb Vasc Bio, 2008, no 28, p. 370.