Venous insufficiency is a major problem that most often affects women. Varicose veins and spider veins are clinical manifestations of the disease.

How does venous insufficiency manifest?
Veins are vessels through which oxygenated blood circulates from the legs to the heart. When the walls of the veins do not work effectively, for example due to defective or damaged valves, they dilate resulting in varicose veins. This makes it difficult for the blood to flow upward to the heart, as a result blood pools in the legs and worsens the condition. This is known as venous stasis and gradually progresses to chronic venous insufficiency.

Venous insufficiency: What are the main risk factors?
Chronic venous insufficiency can be due to:
• age
• hereditary factors
• sex
• prolonged standing
• obesity
• diet
• hormonal disorders

What is chronic venous insufficiency?
Inside inner vein walls there is a series of valves, which open to allow blood to flow to the heart and close to prevent the blood flow in the opposite direction. Thus, blood circulation is always directed towards the heart. Venous insufficiency is a condition in which veins do not function properly, their walls degenerate and the valves wear out, causing blood to regress and move away from the heart.

What is phlebitis?
Phlebitis is created near the surface of the skin as a result of dilated veins. It is a condition in which a vein becomes inflamed, causing pain and swelling. It is usually found on feet and ankles and most of the times it does not cause serious problems. It usually manifests itself with legs swelling, itching, skin lesions, etc. Phlebitis can be treated with sclerotherapy, laser and phlebectomy.

What are varicose veins?
Varicose veins are dilated veins. In most cases they are connected to the central superficial veins which are insufficient, that is, their valves are damaged and unable to function properly. Varicose veins, in addition to the cosmetic problem, are also related to poor blood circulation. Blood moves at a slower speed inside them, while vein pressure is particularly high. Their treatment includes the use of elastic compression stockings, which does not solve the problem permanently but slows down their development. Endovascular laser treatment is a modern and very effective method of treating varicose veins.

What are the symptoms of chronic venous insufficiency?

Patients with venous insufficiency may initially feel:
• heaviness
• itching
• night cramps and swelling
They might also notice brown spots on their skin and venous ulcers. A major complication of varicose veins is thrombophlebitis, which manifests with pain, redness and hardening of the skin. In rare cases, the clot may enter the deep venous network or detach, causing a pulmonary embolism. Another complication of varicose veins is the bleeding that can be caused after an injury.

Venous insufficiency: How is it diagnosed?
The doctor will proceed to a careful clinical examination, palpation and review. The severity of the condition depends on the intensity of the spider veins in the area of the ankle, the presence of edema, inflammation, the hardening of the skin or the presence of ulcers. Doppler and triplex ultrasound maps the patient’s venous system and depending on location and extent, the doctor will recommend the appropriate treatment.

Which are the stages of venous insufficiency?
Venous insufficiency is divided into five stages:
• spider veins
• varicose veins
• edema
• skin lesions
• venous ulcer

What therapeutic approach is there to venous insufficiency?
Conservative treatment includes applying a graduated compression stocking, kinesiotherapy, and medication. In the case of primary varicose veins, treatment includes their partial or total removal, and additional sclerosing injections. Newer methods include the use of laser and radio frequencies to remove varicose veins.

Spider veins are treated with foam sclerotherapy, microthermocoagulation and laser.

The treatment of secondary varicose veins is initially conservative and depending on the case may require intravenous or surgical treatment.

How is chronic venous insufficiency caused?
Chronic venous insufficiency is a result of valvular insufficiency. Malfunctioning valves may be located in the:

• superficial veins: in this case skin lesions and sometimes varicose veins are created
• deep veins: resulting in swelling and skin lesions.

Is there a way to prevent venous insufficiency?
Venous insufficiency can be successfully treated and it is important to know that disease progression can be prevented. An immediate visit to the doctor, as soon as we notice the first symptoms, is of particular importance. With careful diet, exercise and conservative medication and the use of elastic stocking, the course of venous insufficiency can be delayed.

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