Cardiovascular Medicine IN THE DEPARTMENT OF MEDICINE

Chronic Venous Disease

by John P. Cooke, M.D., Ph.D, F.A.C.C

The major function of veins is to return blood back to the heart. Veins in the legs have one-way valves that allow blood to flow from the legs toward the body and eventually, to the heart. When these valves are functioning properly, they prevent blood from pooling in the legs.

When veins become blocked (as with a blood clot - see "Deep vein thrombosis"), or when the valves fail to work properly, blood will pool in the leg. Pooling of blood in the leg can cause swelling and pain, particularly when standing. These are the first symptoms that occur with chronic venous disease (also known as chronic venous insufficiency). As time goes on, the increased pooling of blood (and increased pressure in the veins) may cause the veins to become enlarged and tortuous ("varicose veins"). Also the high pressures in the veins can cause blood to leak out of the vessels and into the tissues. The blood becomes trapped in the skin, and turns brown. This brownish pigmentation typically occurs around and above the ankles. Over the course of years, the leakage of blood and fluid into the leg can cause damage to the skin. Ulcers of the skin can occur, usually in the ankle area.

To prevent the progression of this disease, the most important therapy is good compressive support. There are a variety of compressive stockings that are useful. In more severe cases, the Circ-Aid device (a form of inelastic compression composed of lightweight fabric and velcro straps) is very helpful. If you have chronic venous disease, you may need to have  your blood thinned so as to prevent further clot formation. This is particularly true if you become hospitalized or immobilized for any reason. Ask your doctor. Also, if you are going on a long trip, don't sit without moving your legs for long periods of time. If you are in a plane, get up and walk every half-hour. If you are in a car, flex your leg muscles, and take frequent rest stops.

Exercise is beneficial, particularly swimming or walking in water (because the veins are supported by the hydrostatic pressure of the water). Walking is good, so long as you are wearing compressive support. A new over-the-counter medicine is now available in the United States, that can reduce pain and swelling of chronic venous disease. Venastat is an extract of horse chestnut seed that is used widely in Europe, and has been shown to reduce the leaking of veins. It is taken as one pill (50 mg standardized extract) twice daily.

Chronic venous disease is very responsive to simple measures that you can initiate with the help of your physician. Prevention can reduce your risk of developing more swelling, pain and varicosity of your veins.

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