From the Guidelines
Lower limb venous insufficiency is primarily caused by primary valvular incompetence or, less commonly, prior deep venous thrombosis (DVT) or extrinsic venous obstruction, as stated in the most recent study 1. The most common causes of lower limb venous insufficiency include:
- Chronic venous hypertension
- Deep vein thrombosis (DVT)
- Varicose veins
- Valve dysfunction in the veins, which prevents proper blood return from the legs to the heart Age is a significant risk factor as vein walls naturally lose elasticity over time 1. Obesity places additional pressure on leg veins, while prolonged standing or sitting reduces muscle pump activity that normally assists venous return 1. Pregnancy increases venous pressure due to hormonal changes and the growing uterus compressing pelvic veins. Genetic factors play a role, with family history increasing risk by 90% 1. Previous leg injuries or surgeries can damage veins or their valves. Certain medical conditions like congestive heart failure contribute by increasing overall venous pressure. Lifestyle factors such as smoking damage blood vessels, while lack of exercise reduces the efficiency of the calf muscle pump. Women are more commonly affected than men due to hormonal influences and pregnancy. Early intervention through weight management, regular exercise, compression therapy, and avoiding prolonged immobility can help prevent progression of venous insufficiency. The Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification system is used to categorize venous disease of the legs according to the severity, cause, site, and specific abnormality 1. The high prevalence of lower extremity chronic venous disease and its related socioeconomic burden emphasize the importance of early diagnosis and treatment 1.
Risk Factors
Some of the key risk factors for lower limb venous insufficiency include:
- Family history of venous disease
- Female sex
- Older age
- Chronically increased intra-abdominal pressure due to obesity, pregnancy, chronic constipation, or a tumor
- Prolonged standing
- Deep venous thrombosis causing damage to valves and secondary revascularization
- Arteriovenous shunting
Prevention and Treatment
The most effective way to prevent progression of venous insufficiency is through early intervention, including weight management, regular exercise, compression therapy, and avoiding prolonged immobility 1. Treatment options for superficial venous insufficiency are intended to alleviate symptoms and reduce the risk of complications, and may include conventional management targeted at reducing reflux, such as surgical removal of the great saphenous vein, or alternatives like vein ablation using laser energy, radiofrequency-generated thermal energy, or chemical sclerosing agents 1.
From the Research
Causes of Lower Limb Venous Insufficiency
The provided studies do not directly discuss the causes of lower limb venous insufficiency. However, they do provide information on the diagnosis, treatment, and management of the condition.
Diagnosis and Treatment
- Diagnosis of venous insufficiency is based on symptoms, clinical findings, and duplex ultrasound 2.
- Invasive treatment cannot be planned without ultrasound 2.
- Thermoablation (laser or radiofrequency) is the first-line treatment for superficial venous insufficiency 2.
- Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are safe and effective treatments for varicose veins and venous insufficiency 3.
- EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins 3.
Management of Varicose Veins
- Patients with varicose veins can be treated with conservative or surgical approaches based on clinical conditions and patient preferences 3.
- Minimally invasive endovascular techniques have changed the recommendations for managing symptomatic varicose veins 3.
- Ultrasound-guided foam sclerotherapy (FS) is associated with a high recurrence rate and can be used in conjunction with other procedures 3.
- Mechanochemical endovenous ablation (MOCA) and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required 3.