Chronic venous insufficiency

It is a pathology, not an isolated symptom. It covers a continuous spectrum, from faint signs to cutaneous complications. Varicose veins are its most visible expression, but they are only one of the stages of the disease.

The mechanism

Venous blood in the lower limbs travels back up toward the heart against gravity. This return relies on muscle contraction, which pushes the blood, and on valves, which prevent its backflow between two contractions.

Chronic venous insufficiency sets in when this pressure no longer drops normally during walking. This is called ambulatory venous hypertension. Two main causes produce it. Valvular incompetence lets the blood flow back downward when the valves no longer close properly. Obstruction, a consequence of thrombosis for instance, hinders the return. In both cases, the pressure stays high durably in the venous network, which progressively damages the vein wall and the surrounding tissues.

The CEAP classification

The CEAP classification describes chronic venous disease along several axes, including the clinical axis, graded from C0 to C6.

This grading places a given patient within the course of the disease. It runs from telangiectasias, the first visible lesions, to the open ulcer, the most advanced complication. The passage from one stage to another is neither automatic nor irreversible, but the classification provides a common language for describing the venous condition.

From symptom to complication

Chronic venous insufficiency develops along a continuum. The first signs are often functional: heavy legs, aches, a sensation of swelling at the end of the day. Then come the visible signs, telangiectasias then varicose veins, followed by edema.

At the advanced stages, venous hypertension affects the skin. Trophic changes appear, up to the venous ulcer, a loss of skin tissue that struggles to heal. Management aims to reduce venous hypertension, notably by treating reflux at its origin.