Venous insufficiency: what it is, what are the causes and how to treat it

Overweight, obesity, long standing, postural vices, lack of physical activity, familiarity with circulatory problems, over 45-50 years of age and female sex. These are the main risk factors for venous insufficiency, a pathological condition due to a difficult return of blood to the heart.

Having to overcome the force of gravity which naturally pushes downupward blood flow is allowed by a long series of valves that work like hinged windows: they open to allow the passage of blood to the heart and then close to prevent it from going back “, explains doctor Gianluigi Rosiangiologist at the GVM – Anthea Hospital in Bari. «If these valves they do not have a good seal, blood tends to pool in the legs, dilating the veins and causing a swelling condition known as edema, which must be investigated by the doctor to arrive at a differential diagnosis excluding other causes, such as a heart or kidney problem “.

What is venous insufficiency

The lower limbs are equipped with a double venous system: the superficial one (formed mainly by the great saphenous and the small saphenous), which drains about one third of the blood returning to the heart; the deep one (iliac, femoral, popliteal and deep femoral veins), which drains the other two thirds.

“Venous insufficiency it involves the superficial circle, where on average there is a valve every 10-12 centimeters, although the veins are subject to numerous anatomical variations, different from person to person “. If not properly treated, the situation can degenerate and turn into a chronic pathology, leading to the formation of varicose veins or even the superficial venous thrombosis.

What are the causes of venous insufficiency

To promote venous insufficiency are the work activities that force you to spend long time standing or that expose to heat sources (such as bakers or hairdressers), overweight and obesity, low physical activity, the habit of wearing high heels and clothing that is too tight on the lower limbs or abdomen, which can prevent proper circulation.

“Also there sedentary lifestyle can predispose to the problem, especially if we often keep them legs crossed: in the computerized professions, for example, where the stay in front of the PC is prolonged, the advice is to always sit with your legs parallel, perhaps resting your feet on a low platform “, suggests Dr. Rosi. “In summer, however, we avoid long exposure to the sun or at least bathe in the sea, swimming pool or with refreshing sprays at least every quarter of an hour”.

What are the symptoms of venous insufficiency

To make us suspicious must be a sense of heaviness at the level of the lower limbs, especially at the end of the day, which over time can be associated with itching (first nocturnal, progressively also diurnal): “The latter can evolve into eczema and various visible changes, because the skin can become dry and scaly or moist and sticky, leading to the formation of brown spots which, in some cases, spread to surrounding tissues.

In severe cases they can also appear ulcerationswhich have a slow healing and a high risk of infection, but the most serious complication is certainly the formation of a blood clotcalled thrombus, which obstructs the vein and causes a superficial venous thrombosis, recognizable by the hardening and redness of the varicose tract, as well as by heat and pain “.

How to get to the diagnosis

To confirm the diagnosis of venous insufficiency, in addition to the physical examination by the specialist who inspects and palpates the lower limbs, it is necessary to undergo theechocolordoppler, a non-invasive examination similar to an ultrasound that, thanks to the use of ultrasound, allows you to visualize the veins providing information on the shape and blood flow inside them. At that point, it is possible to decide on the best treatment, even if the first step is always the elastic compression:

“With the help of the doctor it is important choose the best graduated compression stockings, which are not all the same: there are the therapeutic ones, necessary when there are already circulatory problems, and the preventive ones, indicated for those at risk. The pressure exerted is indicated on the package, expressed in millimeters of mercury, mmHg, which must be at its maximum at the ankle and then decrease as it rises towards the thigh: this prevents the veins from dilating and wearing out, maintaining their efficiency “.

How venous insufficiency is treated

Elastocompression accounts for 70% of the therapeutic success, so it is fundamental. Next, the doctor can recommend some supplement (nutraceutical) or drug (phlebotonic) support, for example based on diosmin and hesperidin in the first case, mesoglycan or sulodexide in the second case, which perform an endothelial action, i.e. they reduce inflammation of the venous walls and help the veins not to aggravate.

“Sometimes, however, it may still be necessary to have surgery. Today, minimally invasive intervention methods are available, which compared to the traditional approach do not provide for the complete removal of the varicose vein: this, in fact, can be de-functionalized, i.e. deprived of its functions, through closure, which can be induced by heat. , for example with the laser, or with theinjection of sclerosing chemicals.

In the latter case we speak of ultrasound-guided scleromousse, which stimulates the “closure” of the diseased tract, so that the blood no longer flows back into it but finds alternative ways to reach the heart, through the other multiple venous channels of the leg ». Minimally invasive modalities allow reduced hospitalization times, a quick resumption of daily activities and less post-operative pain, but obviously no intervention is decisive: «The cause that determined the venous insufficiency cannot be eliminated, so it acts over time on other veins, making them sick. In other words, it can be cured, but it cannot be healed. After the operation, therefore, elastic compression continues to be fundamental, as well as maintaining a correct lifestyle », concludes Dr. Rosi.