Venous Insufficiency

What Is Venous Insufficiency? 

Arteries pump oxygen-rich blood from your heart to the rest of your body. Veins bring blood back to your heart to get more oxygen. Venous insufficiency is a condition that occurs when your veins have a hard time sending blood back to your heart.

Your veins contain valves that open and close to keep blood flowing toward your heart. In venous insufficiency, these valves don’t open and close as they should. As a result, blood can pool in your veins, causing uncomfortable symptoms. 

Venous Insufficiency Symptoms 

People with venous insufficiency tend to get varicose veins. Varicose veins are enlarged veins. They develop when backward blood flow increases the pressure in your veins. 

Most often, venous insufficiency symptoms affect your legs. You may experience: 

• Aching
• Cramping
• Heaviness
• Pain
• Swelling

In severe cases, you can develop wounds or ulcers (open sores) that don’t heal. When you get appropriate treatment, these complications are rare.

Causes of Venous Insufficiency 

Venous insufficiency develops when the valves in your veins become damaged. This damage often occurs because of excess pressure in your veins. Sitting or standing for long periods regularly, smoking and not exercising all contribute to this increased pressure. 

Risk Factors for Venous Insufficiency 

Most people with venous insufficiency have a family history of varicose veins. Other risk factors for the condition include: 

• Age over 50
• History of blood clots or deep vein thrombosis 
• Not exercising enough
• Obesity
• Pregnancy
• Prior leg injuries, such as ones you get in a car accident 
• Sitting or standing for long periods
• Smoking

Diagnosing Venous Insufficiency 

Venous insufficiency diagnosis starts with a conversation about your symptoms. Your doctor asks questions such as: 

• Do your symptoms interfere with your daily activities? 
• Is there anything that relieves your symptoms? 
• What activities worsen your symptoms? 

They also ask about your family history and personal history of vein problems or surgeries. Then they physically examine your legs for signs of venous insufficiency, including: 

• Darkened or brownish veins
• Edema (swelling due to fluid buildup) 
• Varicose veins 
• Wounds or ulcers

You may get a duplex ultrasound. This noninvasive test uses sound waves to create images of your vein system. It maps your veins’ anatomy and size. It also tells us how severely blood is leaking backward in your veins (reflux). 

Venous Insufficiency Treatment 

There are many effective treatments for venous insufficiency. You and your doctor determine the best care plan based on the condition’s severity, as well as your lifestyle, overall health and preferences. Your treatment may include: 

Lifestyle changes 

Treating venous insufficiency usually starts with lifestyle changes. Your doctor may recommend: 

• Avoiding prolonged sitting or standing 
• Exercising regularly 
• Elevating your legs 
• Losing weight, if needed
• Wearing medical-grade compression stockings, especially in the morning and during long periods of sitting or standing 

Endovascular procedures

If noninvasive treatments don’t control your symptoms, your doctor may recommend an endovascular treatment. These minimally invasive procedures use small, flexible tubes (catheters) inserted into a vein. You receive local anesthesia so that the area being treated remains numb. You may have: 

• Radiofrequency ablation (RFA): We use ultrasound imaging to place a small sheath in your saphenous vein, a superficial vein in your leg, using local anesthesia. Then, we insert a small catheter with a heating source through the sheath. The catheter heats the vein from the inside to close it. RFA is the most common procedure for venous insufficiency. RFA is also known as endovenous thermal ablation. 
• Polidocanol endovenous microfoam (PEM): Your doctor uses ultrasound guidance to place a small sheath in your leg vein under local anesthesia and insert a catheter. Then, they inject the microfoam through the catheter. The foam closes off your affected vein. 
• VenaSeal™: This treatment is similar to PEM. Instead of injecting microfoam, your doctor uses a special glue. 

All these treatments are types of embolization, procedures that close veins. PEM and VenaSeal are forms of sclerotherapy, which involves injecting liquid or foam into a vein. 

You return home the same day after an endovascular procedure. You wear a compression bandage around your leg for two days. Most people resume their usual activities within one to two weeks. 

Stab phlebectomy 

Sometimes, you may have some remaining varicose veins after an endovascular procedure. A stab phlebectomy is a minimally invasive technique to remove these veins. It’s also called microphlebectomy or ambulatory phlebectomy.

You get local anesthesia so that the affected area remains numb throughout the procedure. During a stab phlebectomy, your vascular surgeon: 

1. Makes a few tiny incisions over the varicose vein 
2. Uses a crochet-like hook to remove the vein 
3. Closes the incisions 
4. Applies a compression bandage to the affected area 

Recovery is similar to an endovascular procedure. You return home the same day and wear a compression bandage for about 48 hours. You gradually resume your activities within one to two weeks. 

Vascular surgery 

Rarely, your doctor may recommend a surgery called ligation and stripping. You may need this treatment if you have extensive vein damage that we can’t easily treat with an endovascular procedure. You receive conscious sedation, a type of anesthesia to help you remain relaxed and comfortable. 

Your vascular surgeon makes a few incisions over the affected vein. They may tie off the vein (ligation) or remove it altogether (stripping).

You return home the same day. Full recovery takes up to four weeks.

What Happens After Closing a Vein? 

Many techniques to treat venous insufficiency involve closing the affected vein. During these treatments, we close diseased superficial veins, the veins that exist outside of your muscles. 

It’s safe to close or remove superficial veins. The blood that previously flowed through those veins will naturally reroute to your deep veins. Your deep veins are the ones in your muscles. 

Providers 

Our vascular surgeons treat hundreds of patients annually using the latest treatments and technology. They are active researchers and physician-scientists who author scientific papers, book chapters and presentations. You receive care from experts striving to move the field forward. 

Contact Us

Call 310-206-6294 to learn more about vascular and endovascular surgery services at UCLA Health.