Chronic venous insufficiency is primarily caused by malfunctioning vein valves that can cause swelling or edema in the legs. This unwanted buildup of pressure can be related to prolonged periods of sitting or standing, development of varicose veins, or more serious factors like deep vein thrombosis, a type of blood clot. Incompetent or damaged vein valves may not close properly to ensure blood only flows in one direction, which is back to the heart.
Venous disorders allow blood to pool in tissue and the backflow or reflux of blood increases pressure in the veins that often leads to symptoms like swelling, muscle pain and the development of varicose veins. Early signs often include visible spider veins that appear near the surface of the skin as thin red or blue veins. When these subtle symptoms manifest, twisted swollen varicose veins that are bluish to purple may be noticed.
“Venous disorders are quite common in adults,” says Dr. Hans Wolf, director of WOLFPACC and founder of the Physicians Achievement Concept Course. “But as blood flow from the legs to the heart slows down, venous insufficiency can raise blood pressure in the legs causing tiny capillaries to burst. When left unattended, edema may be seen in the lower legs while the skin’s surface in that area may appear reddish-brown, especially after the person sits or stands for long periods of time.”
More severe swelling in the lower extremities starts to allow scar tissue in the veins to trap fluid causing unsightly swelling below the knee and around the ankle. This can cause a full or heavy feeling with achy, tired legs that can lead to sensations like pins-and-needles, burning or tingling. Continuous venous insufficiency can cause people with CVI to complain of leg cramps in bed at night. Plus, the leathery-looking skin on their legs may flake, itch, or develop open ulcerative sores near the ankles.
What is post-thrombotic syndrome?
Although several terms can be used to reference problems related to damaged leg veins, post-thrombotic syndrome is a form of chronic venous insufficiency caused by deep vein thrombosis (DVT), which is a blood clot located deep in a leg vein. In fact, post-thrombotic simply means “after a blood clot.” However, after the clot is gone, thrombosis can trigger the production of damaging scar tissue in the veins. It is estimated that up to half of the adults who have DVT could develop post-thrombotic syndrome within months to a couple of years.
Symptoms like heaviness, swelling and pain can significantly impact the person’s quality of life. These tend to worsen with activity but may improve with rest. Unfortunately, post-thrombotic syndrome that develops from DVT is a chronic, lifelong condition with symptoms that come and go over time. Severe cases can lead to feelings of warmth in the lower leg or the formation of painful venous ulcers that are difficult to treat and can reoccur. Throbbing pain, darkened skin in the area, and swelling may be present, but more often than not only in one leg.
Classification of Venous Disorders
An international ad hoc committee was formed at the Sixth Annual Meeting of the American Venous Forum in February 1994 to create a severity scoring system for chronic venous disease based on clinical manifestations, etiologic factors, anatomic distribution, and underlying pathophysiologic findings focused on the clinical grading of segments, symptoms, signs, and disability. Since its creation, the CEAP Classification System has been subsequently updated and revised multiple times by the Forum to incorporate the latest understanding.
Stages of disorders from venous insufficiency are diagnosed using a medical scale and range from 0 to 6. These stages are determined by the visible signs present at the time of an examination and range from no visible signs to active non-healing venous ulcers. If left untreated, chronic venous insufficiency is a progressive disorder that can worsen over time. Generally speaking, CVI is diagnosed and treated once a person reaches Stage 3 (or higher) to help prevent progression to more advanced stages.
- Stage 0 – Although some individuals may complain about heavy or achy legs, there are no visible signs or symptoms of venous disease.
Stage 1 – Thin red or blue web-like blood vessels are visible. Spider veins may cause discomfort but are mostly a cosmetic concern.
Stage 2 – A venous disorder reaches Stage 2 once varicose veins that are at least 3 millimeters wide are visible during examination.
Stage 3 – Due to blood pooling caused by reflux, edema occurs in the lower legs, ankles and feet but no skin changes are noted.
Stage 4 – Skin changes to color or texture are noticed at Stage 4 with discoloration, flakiness and thickening of the outer layer of skin.
Stage 5 – This stage is marked by a healed venous ulcer caused by poor blood flow that has closed and is no longer an open wound.
Stage 6 – Venous ulcers do not heal on their own and non-healing ulcers that can cause permanent tissue damage may require removal.
Effective management of a venous ulcer does involve addressing the underlying chronic venous insufficiency to minimize swelling, help to control infection, and promote overall wound healing. The four stages of healing include the initial inflammation, deterioration, wound formation, and increase in scar tissue. Compression therapy, debridement of dead tissue, avoiding sitting or standing too long, and elevating the legs can impact venous ulcer healing. Healing times vary and some ulcers may not heal completely without surgical interventions.
NOTE: The CEAP classification system is an internationally accepted standard for medically describing patients with chronic venous disorders and it is used for reporting clinical research finding in scientific journals. This system allows an inter-professional team of healthcare professionals from different specialties to document the level of venous disorder and communicate various aspects about the disease effectively based on clinical signs, etiology, anatomical distribution, and underlying pathophysiology.
President Trump Diagnosed with Venous Insufficiency
The world of photography has never been more dynamic and our news media today relies heavily on this multifaceted landscape with groundbreaking technological advancements. Smartphones with highly advanced cameras have led to a boom of ubiquity and transparency that can be witnessed daily in the photo sharing of the latest political images. This week, there was a White House Press Briefing designed to address the bruising on the back of the President’s hand and swelling in his lower legs that was captured on numerous photos.
Trump’s press secretary immediately stated that after a thorough examination, lab work and medical imaging the President’s condition was classified as non-benign and not related to a blood clot or deep vein thrombosis. It did appear that the White House medical unit was concerned about some symptoms and wanted to know more about what might be causing the venous insufficiency. In recent weeks, President Trump had noticed the swelling but thorough testing showed no signs of heart failure, arterial disease, nor renal dysfunction.
With the great medical care that the 79 year-old Commander in Chief has available, he should have a better than average chance of recovery. But, doctors will likely suggest that the President carefully manage certain lifestyle issues associated with bilateral chronic venous insufficiency characterized by swelling in the lower extremities. Fortunately, there was no sign of arterial sclerosis or deep vein thrombosis. Moreover, the press secretary said the minor bruising on the back of the President’s hand was related to his daily intake of aspirin as part of a standard cardiovascular prevention regime.
“Don’t know that President Trump will follow the helpful lifestyle changes that the White House medical unit may have suggested,” adds Dr. Wolf. “After all, weight management with a healthy diet rich in fruits, vegetables, whole grains and lean proteins top the list of improved personal habits, as well as limiting the processed foods that he has been said to love. Unfortunately, added salt, sugar and trans fats can worsen CVI symptoms. But, drinking enough water to prevent the blood from thickening and wearing compression stockings can certainly help.”
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Today’s medical students will practice medicine at the most advanced time in human history. As physicians they will have access to the latest technologies and artificial intelligence applications used for finite diagnoses that go well beyond the traditional differential diagnosis of potential conditions. Dr. Hans Wolf devoted decades to developing WOLFPACC’s Power 5 Methodology that helps medical students understand how to apply the basic sciences they learned in medical school to the clinical task at hand. Find out today how WOLFPACC can help you apply the knowledge you’ve gained to ensure a successful career in medicine.
Photo credit Ivan Samkov
