The blood that is difficult to trace back from the periphery to the center, that is, from the lower limbs to the heart, is the characteristic trait of venous insufficiency. It is a chronic disorder that can cause the onset of some more or less serious disorders, from varicose veins to thrombophlebitis, ulcers, up to thromboembolism, the latter fortunately being a very rare event. “For these reasons, people predisposed to venous insufficiency must try to prevent this condition from progressing,” adds Dr. Elisa Casabianca, Humanitas vascular surgeon.
A difficult ascend
Venous circulation is the circulation that brings blood back from the bottom of the body upwards, that is, from the legs and feet to the heart. In the presence of venous insufficiency, the blood cannot adequately perform this process in the superficial veins of the legs: “It is a chronic disorder associated with the laxity of the venous tissue, with a defect in the closure of the vein valves. So the blood does not go to the heart but stagnates,” explains the doctor.
What does this change in blood circulation mean? “It increases the pressure of venous blood in the ankles, there is a feeling of swelling in the legs, especially in the evening, and especially in summer or when temperatures are higher.
In addition, venous insufficiency can cause one of the most common and well-known vascular disorders, particularly in women: “Surface veins can expand and become more commonly known as varicose veins. Moreover, – continues the specialist – over time venous insufficiency may favor the release of some parts of hemoglobin in the inner face of the ankle. Bluish stains can arise at this point, and the skin of the ankle progressively thickens, becomes dry and dystrophic. This is not only an aesthetic defect but also a condition that should not be underestimated because these tissues lack cell oxygenation and this can lead to the formation of painful ulcers, which heal with extreme difficulty”.
If the disorder progresses, it can be possible to reach the onset of thrombophlebitis and even thromboembolism: “The formation of clots in the varicose veins where the blood tends to stagnate represents the so-called phlebitis, a pathology which does not endanger but affects the quality of life and requires an adequate treatment. Pulmonary embolism is finally a remote possibility and it is always related to blood clotting: a superficial thrombus could lead to embolism if it enters into deep circulation”.
Who is most at risk?
The main risk factor for venous insufficiency is family history. Weight gain and sedentariness are also conditions that can promote venous insufficiency in these individuals: “Prevention should be a priority for these individuals and it should be aimed at avoiding the risk of worsening the venous insufficiency. Those who spend many hours standing for professional reasons, especially in warm environments, such as kitchens, must keep their lower limb muscles active. The muscles push the blood upwards, improving venous return. It is always very useful to wear compression stockings that help the veins do what they can no longer do properly,” recalls Dr. Casabianca.
The indication not to smoke or to stop smoking is always valid even if cigarette smoking does not represent a specific risk factor for venous insufficiency, “while it is more so for peripheral arterial disease”.
Women predisposed to venous insufficiency must also pay attention to two other elements: exposure to sexual hormones through the intake of contraceptives and hormone replacement therapy, and pregnancy. “The “pill” and replacement therapy worsen venous insufficiency and increase the severity of symptoms. Pregnancy is also associated with an increased risk of venous insufficiency due to the hormonal changes the woman undergoes and the weight gain due to the pregnant uterus,” Dr. Casabianca concludes.