If the blood in your veins does not flow properly, it can interfere with the way that your skin exchanges oxygen, nutrients and waste products with your blood. If the exchange is disrupted over a long period of time it is known as chronic venous insufficiency. It can be caused by untreated varicose veins, calf muscle pump failure and past history of deep venous thrombosis.
Chronic venous insufficiency is associated with complications as described below:
Varicose eczema is a condition that causes your skin to become red, scaly and flaky. it may be itchy. You may also develop blisters and crusting of your skin.
Lipodermatosclerosis causes your skin to become hardened and leathery tight. It is associated with marked skin hyperpigmentation with dark brown colour. The condition usually affects the skin area (gaiter area) just above the ankle. Lipodermatosclerosis is a warning sign. Unless the underlying cause is treated, the patient is at high risk of developing a venous ulcer
Venous ulcers are damage and loss of skin above the ankle. They are common in patients with CVI. They are difficult to heal and often recur.
Approximately about 20% of patients will develop venous ulcers around the ankle. For patients with varicose veins, endovenous techniques and surgical stripping offer patients with great chance for relief of symptoms and consequently improved in quality of life.
Conservative management form an important aspect of treatment for this group of patients especially those (e.g. calf muscle pump failure and deep venous disease) not amendable with endovenous /surgical options.
The goal of conservative management is to provide symptomatic relief such as leg swelling, leg pain, leg cramps and restless leg syndrome and improve quality of life.
It will also help to prevent recurrent of varicose veins and complications. They do not permanently correct the venous reflux.
Conservative Treatment Options
- Graduated Compression Stockings/ Bandaging
The gold standard for conservative treatment of patients with CVI are medical grade graduated compression stockings and compression bandaging (for patients with venous ulcers). They are able to improve symptoms as a result of deep, superficial or combined deep/superficial venous reflux
Graduated compression stockings / bandaging effectively reduce the hydrostatic pressure by reduction of blood pooling in the leg and thus minimize vein related symptoms.
Compression stockings/bandaging have also been shown to improve calf muscle function. The effective pressure of compression at the ankle should be between 30 – 40 mmHg. However compliance is crucial as the effects of compression will only last as long as you wear them.
In our practice, we offer many options with compression stockings.
This is an important factor influencing patient’s compliance. The stockings need to be properly measured and fitted for knee length, thigh length or pantyhose length as guided but doctor. Some patients may require custom made stockings if their leg size did not fit standard off the shelf stockings.
We take great care in getting the right size of stockings with optimal compression pressure for our patients in order to achieve the maximum benefits of stocking.
Wrongly measured and fitted stockings potentially can result in discomfort/ pain, skin ulceration or foot swelling. Our stockings also come in different colour, fabric and style, giving patients a wider choice and greater satisfaction.
- Weight Loss
Weight loss will lead to decrease in resistance of venous return to the heart and thus decrease venous pressure in the legs.
- Leg Elevation
Elevating the legs above the heart will improve venous drainage from the legs. Reduction of venous pressure in the legs by reduction of blood pooling in the legs will help to improve symptoms fro venous reflux.
During exercise, the calf muscle pump will be activated, pushing blood in the deep veins towards the heart. Reduction of blood pooling in the legs will lead to decreased in venous pressure.
Non-steroidal anti-inflammatory medications and Horse Chestnut Seed Extract (Aesculus hippocastanum) have been shown in some studies to be effective in vein related symptom relief.