Chronic venous disease results from damaged valves in the veins that no longer close tightly. Blood leaks backward through the faulty valve, collecting in the vein below. If the vein is a superficial vein, the condition is called a varicose vein ; if it is a deep vein, the condition is called venous stasis disease or chronic venous insufficiency .

Causes of Chronic Venous Insufficiency include conditions that cause the vein valves to no longer close tightly such as the following:

• Severe or long term swelling from backward blood flow in the veins
• Untreated DVT, with resultant damage to venous valves

• Pain and discomfort
• Lower extremity swelling caused by pooling of blood
• Discoloration of the ankle or lower leg area
• Induration or a pitted appearance of in the affected area
• Ulcers, sores that are difficult to heal or skin breakdown
• Change in temperature of the leg

Non-Invasive Testing: Non-Invasive Testing is done in the vascular laboratory either at the Beachwood office or downtown at the hospital. This is performed to check the blood flow in your veins. Non-Invasive tests are painless and have no risks or side effects. They do not involve the use of needles, x-rays, or dye and no special preparation is required before the test and no observation is required afterwards. This allows the tests to often be done the same day as the office visit depending on the schedule of the laboratory. All non-invasive tests take less than one hour to perform and the results are given to Dr. King for evaluation. Most often, you will discuss the results by telephone. There are several types of Non-Invasive tests that the doctor may order:

• Venous Doppler Exam uses ultrasound to send high frequency sound waves, which are reflected from moving red blood cells. This test is used to diagnose blood clots or weak valves in the legs. During the test, you will be asked to lie down and slightly bend your knees into a frog-legged position. The examiner places the probe over veins at various locations on your legs and listens with a device that looks like a stethoscope. You may be asked to take a deep breath and hold it, then to release it quickly at times during the test.
• Duplex Imaging is used to diagnose many different problems in the legs including blood clots and weak valves. This ultrasound examination changes the sound waves into a picture of your veins on a video-imaging screen. The examiner will place a cool, wet-feeling gel on various parts of your legs and then run a probe over the veins to view them while you change positions from standing, lying on your back and occasionally on your stomach.
• Impedance Plethysmography (IPG) evaluates the flow of blood within the major veins of the legs and to diagnose blood clots. The examiner will place a blood pressure cuff on your thigh and plastic strips on your calf while you are lying down. The thigh cuff will be inflated during past of the test. The plastic strips are connected to a machine which records blood volume and blood outflow in your veins. This test has been replaced bt duplex imaging in most cases.
  

Invasive Testing

• Venograms are special x-ray pictures of veins used to diagnose blood clots and to obtain more specific information about the venous system. Usually performed in the x-ray department as an outpatient, since this examination requires the puncture of an artery and the injection of dye, you will be asked to sign a consent form. You will remain awake, although you may be given medication to help you relax. When the dye is injected there is often a brief, hot burning sensation experienced by the patient. In most cases, if a clot is present it will be shown on the x-ray.
• Venous Pressure Measurements are used to evaluate chronic venous insufficiency through measurements of venous pressure and the function of venous valves. A small needle is placed in a surface vein of the foot and connected to a machine that will measure pressure. The pressure readings are usually compared while lying, sitting, and pumping the foot so that the function of your valves can be evaluated.

Treating Chronic Venous Insufficiency
The treatment and management of chronic venous insufficiency is difficult due to many associated complications. It is important to start treatment as soon as there is evidence of the condition. The ultimate outcome depends on preventing swelling.

• Leg elevation above the level of the heart several times per day
• Compression stockings worn on a regular daily basis whenever the patient is out of bed
• Exercise on a regular basis
• Avoidance of sitting or standing in one position for long periods
• Anticoagulants or daily aspirin
• Antibiotics for infection
• Compression with a special pump to reduce swelling
• Weight reduction
• Custom Compression Hose Elastic support stockings may be useful in keeping the symptoms under control, but they will not cure varicose veins or deep venous insufficiency. The compression of the stocking functions similar to the muscles in the leg, squeezing the veins so that the blood is pushed upward. This is especially useful for people who must post-pone surgery, such as pregnant or very obese patients who must lose weight before surgery. Custom fit compression stockings should be prescribed by your doctor and carefully fitted for the best results. It is essential that they give plenty of support to the lower leg without squeezing the calf or thigh and the doctors' prescription ensures exact compression distributed in a graduated manner up the leg. Stockings should be put on as soon as you get out of bed and be worn on all day.
  • Compression stockings are most effective when leg swelling is at a low point, such as after elevation or in morning.
  • The compression counters, or balances the increased venous pressure in the legs.
  • The compression reduces venous volume in the legs, increases venous flow.
  • The compression supports superficial veins and improves flow in the deep venous system.