Chronic Venous Disease: Varicose Veins And Venous Insufficiency
Signs, Symptoms, And Complications
The early stages of venous disease may not cause any symptoms. As the disease progresses, several symptoms affecting the legs may arise, including heaviness, aching, tiredness, itching, cramps, tingling, swelling, and pain. Symptoms become worse later in the day, and are worsened by menses, heat, and standing for long periods (Fort 2017a; Wittens 2015; Scherger 2012).
Clinical signs of chronic venous disease are classified along a continuum according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) criteria. In general, an increasing clinical score corresponds to increasing disease severity (Fort 2017a; Eberhardt 2014).
Clinical Classification of Chronic Venous Disease
- C0: No visible or palpable sign of venous disease
- C1: Telangiectasias (spider veins) or reticular veins (veins that “feed” spider veins)
- C2: Varicose veins
- C3: Edema (swelling)
- C4: Changes in skin and tissues underneath the skin
- A: Pigmentation or eczema
- B: Thickening, hardening, swelling, redness, inflammation, scarring
- C5: Healed venous ulcer
- C5: Healed venous ulcer
- C6: Active venous ulcer
It is important to note that some potential complications of venous disease, such as deep vein thrombosis, can occur even in people who have no overt signs corresponding with any of the aforementioned stages.
Complications of untreated chronic venous disease include (Fort 2017a; Eberhardt 2014; NIH 2014b; Nicholls 2005):
- Superficial venous thrombophlebitis – a blood clot in a vein close to the skin surface; may cause severe pain and other problems.
- Bleeding – often results from local trauma but can be spontaneous; elderly patients have increased risk; can be life threatening if extensive.
- Lymphedema – buildup of lymphatic fluid in tissues under the skin.
Venous ulcers are one complication of venous disease that requires careful attention. The ulcers typically affect the lower part of the leg and ankle, are typically painful, exude fluids, and can become quite large; venous ulcers are also often recurrent (Bongiovanni 2015). It is important that a trained physician diagnose venous ulcers to differentiate them from other types of ulcers that can affect the legs, such as arterial ulcers and pressure ulcers. Venous ulcers are the most common type of chronic ulcer affecting the lower leg, accounting for 70‒80% of leg ulcers. Although the development of venous ulcers is complex, the primary mechanism involves high pressure in the leg veins, which causes fluids and molecules to leak into the surrounding tissue causing inflammation and tissue damage. Venous ulcers can cause substantial pain, and considerably reduce quality of life. Evidence suggests that the best outcomes can be achieved when ulcers are managed by a multidisciplinary wound-care team (Marola 2016).
Chronic Venous Disease and Deep Vein Thrombosis
Venous insufficiency and varicose veins are associated with increased risk of a serious condition called deep vein thrombosis, or DVT (Heit 2000; Shaydakov 2016; Muller-Buhl 2012). Poor venous blood flow creates an environment conducive to the formation of blood clots (NHS 2016b). DVT occurs when a blood clot forms in a deep vein, usually in the legs, impairing blood flow. Signs of DVT in the legs include leg swelling, redness, pain, or tenderness (Patel 2016; NHS 2016a).
One potentially deadly consequence of DVT is pulmonary embolism (Ginsberg 2016). This complication occurs when the blood clot dislodges from the deep vein and travels to the lungs, undermining the ability of the lungs to oxygenate the blood (NIH 2011). Pulmonary embolism can cause shortness of breath, chest pain, dizziness, elevated heart rate, low blood pressure, and even sudden death (Di Nisio 2016; NIH 2011; Mayo Clinic 2014).
Suspected cases of DVT or pulmonary embolism require rapid evaluation (Mayo Clinic 2014; NHS 2016a). Medical professionals will use a variety of tests to determine a patient’s immediate risk and devise a treatment plan. Depending on the location and extent of the blood clot, treatment may include anticoagulant medications or medications that break existing blood clots (thrombolytics). After the patient stabilizes, several months of maintenance therapy with anti-platelet (eg, aspirin) or anticoagulant medications is typically necessary to prevent recurrences. The duration of maintenance therapy will depend on each patient’s risk-benefit profile: anticoagulant medications increase the risk of major bleeding events, so that risk must be weighed against the likelihood of recurrence if maintenance therapy is stopped (Di Nisio 2016; Ginsberg 2016).
Fortunately, several lifestyle changes and natural interventions may help prevent dangerous blood clots. More information on ways to reduce risk is discussed extensively in the Blood Clot Prevention protocol. However, anyone who suspects they may have a DVT should consult a qualified healthcare provider right away.