What is Chronic Venous Insufficiency?

Author: Dr. Kim Langdon Cull

People with diabetes face an increased risk of developing vascular diseases, which can be either symptomatic or asymptomatic. Two common vascular conditions associated with diabetes are Peripheral Artery Disease (PAD) and Venous Insufficiency. Both conditions can lead to severe complications in the heart and kidneys if left untreated.

What is Venous Insufficiency?

Venous insufficiency occurs when blood in the veins doesn't flow back correctly to the heart, causing it to leak backward down the veins. Unlike arterial blood, which is rich in oxygen, venous blood carries lower oxygen levels and higher amounts of carbon dioxide. Usually, the veins contain valves that prevent blood from pooling in the ankles and calves. However, with age, poor genetics, or disease, these valves may weaken, leading to blood accumulation and swelling in the legs.

Venous insufficiency is a common but serious condition. Left untreated, it can lead to Chronic Venous Insufficiency (CVI). This progressive disease can result in life-threatening complications such as non-healing ulcers or infections in the lower extremities.

Causes and Risk Factors for Venous Insufficiency

Untreated venous insufficiency in superficial or deep veins can cause Chronic Venous Insufficiency (CVI). Common symptoms include leg pain, swelling, and changes in skin texture, such as lipodermatosclerosis, which can ultimately lead to ulcers. CVI is more likely to occur in older adults and those with a history of Deep Vein Thrombosis (DVT), which can damage the venous valves, causing blood backflow and increased pressure within the veins.

Other risk factors for CVI include:

• Obesity
• Sedentary lifestyle
• Prolonged standing
• Smoking
• Diabetes

In people with diabetes, poor blood sugar control and obesity can increase the likelihood of developing CVI. Both superficial venous valvular incompetence and profound venous system failure can lead to complications. Superficial issues often result in varicose veins, while deep vein problems can lead to blood clots or DVTs.

How Does Chronic Venous Insufficiency (CVI) Develop?

CVI occurs when venous hypertension—increased pressure in diseased veins—reduces blood flow. This stagnation of blood can trap white blood cells, releasing enzymes and free radicals, which cause oxidative stress and inflammation.Over time, fluid accumulation deprives tissues of oxygen, increasing the risk of ulcers, phlebitis, and blood clots.

In addition to low oxygen levels, trapped white blood cells can trigger the release of clotting factors, further damaging surrounding tissues and increasing the risk of non-healing sores or ulcers.

Mechanisms of Venous Valve Failure

Several factors contribute to venous valve failure, including:

• Congenitally weak veins: Dilated veins place increased pressure on the valves, making them more susceptible to failure.
• Injury or superficial phlebitis: Direct vein damage can weaken the valves.
• Sedentary behavior: Lack of movement causes prolonged high venous pressure, leading to venous stasis(slowed blood flow), which can further damage the veins.

This impaired blood flow can cause lactate buildup and other waste products, making the tissues more prone to infections and ulcers. In severe cases, CVI can lead to blood clots and non-healing leg ulcers.

The Role of P-Selectin in CVI

Research has identified elevated levels of P-selectin, which acts as a "sticky" substance within blood vessels, contributing to CVI. P-selectin activates platelets and promotes blood clotting, which can further reduce oxygen levels in tissues and contribute to forming ulcers and sores.

Preventing Venous Insufficiency and CVI

If you have diabetes or other risk factors for venous insufficiency, it's essential to take preventive measures:

• Stay active: Walking for at least 30 minutes daily can significantly improve circulation and reduce the risk of venous insufficiency and blood clots.
• Maintain a healthy weight: Obesity is a significant risk factor for venous insufficiency, so weight management is crucial.
• Avoid prolonged sitting or standing: If your lifestyle or job requires long periods of inactivity, try to take regular breaks to stretch and walk.
• Manage blood sugar levels: Controlling diabetes can help minimize the risk of vascular complications, including venous insufficiency.

Conclusion

Venous insufficiency is a serious condition that can lead to chronic health problems, including ulcers and blood clots. People with diabetes are especially at risk due to poor circulation and high blood sugar levels. The good news is that regular physical activity, proper diabetes management, and maintaining a healthy lifestyle can help prevent venous insufficiency and its complications.

References

• Renner R, Gebhardt C, Simon JC, Seikowski K. Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcers. J Dtsch Dermatol Ges. 2009 Nov. 7(11):953-61. [Medline].
• Zaniewski M, Simka M. Biophysics of venous return from the brain from the perspective of the pathophysiology of chronic cerebrospinal venous insufficiency. Rev Recent Clin Trials. 2012 May. 7(2):88-92. [Medline].
• Bryan LJ, Callas PW, Criqui MH, Cushman M. Higher soluble P-selectin is associated with chronic venous insufficiency: the San Diego Population Study. Thromb Res. 2012 Nov. 130(5):716-9. [Medline].