Chronic VENOUS INSUFFICIENCY
Varicose veins and deep vein thrombosis may contribute to venous congestion resulting in chronic venous insufficiency
Our Services
Conservative
Management
The majority of patient with chronic venous insufficency can be treated effectively with
Elevation of limbs at rest
Weight control
Exercise
Smoking cessation
Compression bandages
Compression hosiery
Endovenous
Procedures
These less invasive procedures, are the preferred technique and is often considered as a first line strategy.
THIS PRACTICE DOES NOT OFFER ENDOVENOUS PROCEDURES FOR CHRONIC VENOUS INSUFFICIENCY
Venous
Procedures
Open venous surgical procedures attempt to bypass obstructed veins
THIS PRACTICE DOES NOT OFFER SURGERY FOR CHRONIC VENOUS INSUFFICIENCY
Wound Care
We offer the whole range of conservative wound care modalities as well as advanced wound care modalities including surgical debridement, negative pressure wound therapy and / or hyperbaric oxygen therapy for complex wounds related to venous insufficiency.
Chronic Venous Insufficiency
Arteries bring oxygen-rich blood from your heart to the rest of your body. Veins return oxygen-poor blood back to your heart. When your leg veins cannot pump enough blood back to your heart, you have chronic venous insufficiency (CVI). It is also sometimes called chronic venous disease (CVD). You have three kinds of veins, superficial veins, which lie close to the skin, and deep veins, which lie in groups of muscles. Deep veins lead to the vena cava, your body's largest vein, which runs directly to your heart. Perforating veins connect the superficial to the deep veins. The blood in your leg veins must go against gravity to return to your heart. Your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing backward. The entire process of sending blood back to the heart is called the venous pump.
When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and increase venous pressure. Deep veins and perforating veins are usually able to withstand short periods of increased pressures. But sitting or standing for a long time can stretch vein walls because they are flexible. Over time, in susceptible individuals, this can weaken the walls of the veins and damage the vein valves, causing chronic venous insufficiency.
Symptoms
If you have chronic venous insufficiency, your ankles may swell and your calves may feel tight. Your legs may also feel heavy, tired, restless or achy. You may feel pain while walking or shortly after stopping. Chronic venous insufficiency may be associated with varicose veins. Varicose veins are swollen veins that you can see through the skin. They often look blue, bulging, and twisted. Large varicose veins can lead to skin changes like rashes, redness and sores (ulcers). Chronic venous insufficiency can also cause problems with leg swelling because of the pressure of the blood pooling in the veins. Your lymphatic system may also produce more of a fluid called lymph to compensate for chronic venous insufficiency. Your leg tissues may then absorb some of this fluid, which can increase the tendency for your legs to swell.
Causes
Long-term high blood pressure inside your leg veins causes chronic venous insufficiency. Other causes of chronic venous insufficiency include deep vein thrombosis (DVT) and phlebitis. Deep vein thrombosis occurs when a blood clot (called a thrombus) blocks blood from flowing out of a deep or perforating vein. Blocked veins can increase vein blood pressure, which overloads your valves. Vein valves that do not work properly are called incompetent, and incompetent valves contribute to chronic venous insufficiency. Deep vein thrombosis is a potentially serious condition that causes leg swelling and requires immediate medical attention because sometimes the blood clots in the veins can break off and travel to the lungs. This condition is called a pulmonary embolism.
Phlebitis occurs when a superficial vein becomes swollen and inflamed. This causes a blood clot to form (thrombophlebitis), which can also cause deep vein thrombosis. Factors that can increase your risk for chronic venous insufficiency include a family history of varicose veins, being overweight, being pregnant, not exercising enough, smoking, and standing or sitting for long periods of time. Your age and gender can also increase your risk of developing chronic venous insufficiency; patients older than 50 more often develop chronic venous insufficiency.
Tests
First Dr Weir will ask you questions about your current general health, past medical history, and symptoms. In addition, he will conduct a physical exam. Together these are known as a patient history and exam. Dr Weir may measure the blood pressure in your legs and will examine the varicose veins. To confirm a diagnosis of chronic venous insufficiency, Dr Weir may order a duplex ultrasound test. Duplex ultrasound uses sound waves higher than human hearing can detect. Duplex ultrasound allows your physician to measure the speed of blood flow and to see the structure of your leg veins.
Treatment Options
Conservative
The majority of patient with varicose veins can be treated effectively with
Elevation of limbs at rest
Weight control
Exercise
Smoking cessation
Compression bandages
Compression hosiery
For most cases of chronic venous insufficiency, Dr Weir will recommend compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. In this way, compression stockings can prevent ulcers from returning. You have to wear compression stockings daily for the rest of your life. You can help avoid leg swelling and other symptoms by occasionally raising your legs and avoiding standing for long periods of time to decrease the pressure in the veins. When you do need to stand for a long period, you can flex your leg muscles occasionally to keep blood flowing.
Endovenous
Stenting
A select group of patient might benefit in the short term from endovenous procedures during which stenoses or obstructions within the venous system is relieved by means of venoplasty with or without stents. These patients have a very high incidence of recurrence.
THIS PRACTICE DOES NOT OFFER ENDOVENOUS PROCEDURES FOR CHRONIC VENOUS INSUFFICIENCY
Surgery
Bypass Surgery
A select group of patient might benefit in the short term from venous bypass procedures during which obstructions within the venous system is relieved by means of bypass operations. These patients have a very high incidence of recurrence.
THIS PRACTICE DOES NOT OFFER SURGERY FOR CHRONIC VENOUS INSUFFICIENCY
NOTICE
THIS PRACTICE DOES NOT OFFER ANY FORM OF ENDOVENOUS PROCEDURE OR OPEN SURGERY FOR CHRONIC VENOUS INSUFFICIENCY
If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.
Gregory Weir Vascular Surgery
The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
CONSULTATION Rooms
Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria