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In industrialized countries, more than 30% of women and about 10% of men consult for venous signs and symptoms of the legs.
Feelings of heaviness, tiredness and swelling may be present without visible venous disease. Spider veins and varicose veins represent clinical entities requiring special attention. Important factors such as heredity, excess weight, some professions requiring prolonged periods of standing or sitting may increase the risk of developing a chronic venous disease of the legs.
These conditions can evolve and produce complications such as skin pigmentation, chronic oedema, dermititis, eczema, phlebitis and ultimately leg ulcerations.
Deep venous thrombosis may be a consequence as well but it usually occurs without pre-existing venous disease.
The Venous System
The veins carry the blood back to the heart and lungs. Its blue color is due to the low oxygen content.
When standing, more than half of the venous blood is in our legs. The blood transit from the legs to the heart has to overcome gravity. This requires the action of a pump. The pump function is mainly achieved by the foot and ankle movement. During each step the muscles compress the veins located inside the calf muscle thereby allowing the venous blood to rush back to the heart.
The venous blood return
In healthy individuals, venous blood flows mainly from the superficial veins (located right under the skin) to the deep veins, through the muscles. Once in the deep veins, the blood moves up to the heart and the lungs to be re-oxygenated.
In order to direct the blood flow from the foot to the upper leg, and to prevent it from falling back, the leg veins have thin valves that work as a lock system. Thus, they play a major role in the blood return. Defective valves are mainly responsible for the development of venous disease.
Defective Venous Valves
In patients with venous disease, the internal walls of the leg veins are deteriorated and the small valves are defective and incompetent.
When a valve is incompetent, blood flows backward to the foot and from the deep veins to the superficial veins. It is called reflux. When valves are incompetent in the superficial veins only, the deep veins have to carry more blood toward the heart. To compensate, the veins expand and the valves may not close anymore. When this happens, such as in the case of severe varicose veins, the deep vein system may become incompetent also.
When blood is no longer pumped effectively from the lower leg, the peripheral veins will not be emptied even when walking. They remain filled with blood and the pressure in the vein will not reduce. This condition is known as chronic venous insufficiency (CVI) which may result in oedema (swelling), skin change and in some cases ulcerations.
Origins of Venous Disease
The causes of venous disease are not clearly identified yet. However, we know that heredity factors play an important role : if both parents have the disease, there is a 90% chance of developing a venous disorder.
In addition to heredity, there are other factors to consider such as :
- age
- gender
- excessive weight
- pregnancy
- hormonal treatments
- professions requiring prolonged standing or sitting
The most important condition leading to chronic venous insufficiency is thrombosis as valves are destroyed when the vessel is cleared from the clots.
Varicose Veins - A Common Case of Venous Disorder
Varicose veins are one of the most common examples of venous disease in the legs.
The vein is swollen and twisted. The small anti-reflux valves are defective and the venous stasis creates a swelling of the skin.
If not treated, varicose veins can lead to the aggravation of the disease.
- Symptoms of venous hypertension such as heavy legs may be present without a visible venous pathology.
- Varicose veins may be present without symptoms but typically progress and lead to chronic venous insufficiency.
- Chronic venous insufficiency reflects a clinical syndrom of skin changes which may lead to serious consequences such as leg ulceration.
- Acute manifestations of venous disease are serious disorders such as phlebitis, thrombosis, deep venous thrombosis (DVT). These acute disorders usually occur suddenly without pre-existing conditions, but can also be triggered by chronic venous disease.
Can We Cure Venous Disease?
Defective venous valves cannot be replaced or fixed. Superficial venous refluxes can be repaired by surgical removal or sclerotherapy of the varicose vein(s). However, chronic venous disease due to deep venous incompetence - such as in post-thrombotic syndrome - cannot be cured.
Chronic venous disease evolves with time. The therapy consists of methods that help to reduce the "ambulatory venous hyperpressure".
Phlebologists, - physicians specialized in veno-lymphatic diseases -, all agree that compression stockings are THE basic treatment of venous disease. This is the reason why medical compression stockings are recognized as a medicine.
Principle and Action
The concept of compression therapy lies on a simple and efficient mechanical principle : it consists of applying a garment around the leg.
By compressing the limb with graduated compression - strong at the ankle and decreasing going up the leg, the compression stocking helps the venous return, decreases venous pressure, prevents venous stasis and impair of venous walls, and efficiently relieves aching and heavy legs.
Indications and Contra-Indications
This treatment is prescribed by a physician to treat phlebitis, thrombosis, vein surgery aftercare, and to relieve all manifestations of chronic venous disease (heavy legs, varicose veins, oedemas, leg ulcers..). It can also be prescribed to prevent venous troubles during pregnancy and long distance travel.
Contraindications are limited : advanced peripheral obstructive arterial disease, congestive heart failure, septic phlebitis, oozing dermatitis, advanced peripheral neuropathy. Very few cases of allergy have been reported to one of the components.
There are no secondary effects with compression therapy treatment when manufacturer's sizing chart is strictly followed.
Compression Classes
Compression stockings are available in different degrees of compression depending on the severity of the pathology to be treated. The pressure exerted by a compression stocking at ankle level is measured in millimeters of mercury (mmHg). Compression classes are defined according to different official norms (AFNOR in France, GZG in Germany ).
The physician prescribes the compression class corresponding to the pathology of the patient. Light compression is class 1 or 2, strong compression is class 3 or 4 depending on the norm used.
What Can You Do...
MOVE!
Walk, climb stairs, move your legs around the office and at home. Avoid prolonged sitting or standing which may cause leg pain and swelling.
REFRESH YOUR LEGS
After a long tiring day, or during hot season, refresh your legs with a cool shower. Avoid long exposure to heat like sunbathing, hot baths, sauna that may lead veins to dilate and induce swelling.
RAISE YOUR LEGS
In order to ease the venous blood return, elevate your legs at home while sitting on the sofa or lying in bed. At the office, have a leg rest under your desk.
EXERCISE
Regular exercise is always recommended for a healthy body. Some sports reinforce a better venous blood return : swimming, walking, biking, gymnastics, yoga. Sports associated with sudden brutal stops like tennis, squash, hockey, volley ball, basket ball are less beneficial.
MAINTAIN A REASONABLE BODY WEIGHT
Having a healthy diet will help you keep a normal weight thus lowering leg symptoms and swelling.
Page Cite: Sigvaris
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