Chronic Venous Insufficiency: Heavy, Swollen Legs, Causes and When to Be Seen

What it involves

MedlinePlus explains that venous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart. Valves in the deeper leg veins normally keep blood moving forward. In the chronic form the vein walls weaken and the valves are damaged, so veins stay filled with blood, especially when standing.

Who this is for

• Adults with heavy, aching, cramping or swollen legs that worsen when standing.
• Patients with visible varicose veins, itching or darkened, thickened skin on the ankles.
• People with a past leg blood clot, obesity, a family history or jobs that need long hours sitting or standing.
• Anyone with a leg or ankle sore that is slow to heal.

What to expect

• Questions about when the legs hurt or swell, past clots, pregnancy, job, medicines and family history
• An exam of both legs while you stand and sit, checking veins, skin, swelling and pulses
• Blood work, which the practice offers, to look at kidney, liver and heart-related causes of swelling
• A referral for a leg vein ultrasound or a vein specialist when it is appropriate

What it can feel like

The encyclopedia describes dull aching, heaviness or cramping in the legs, itching and tingling, and pain that gets worse when standing and better when the legs are raised. Skin changes include swelling, irritated or cracked skin, red or swollen, crusted or weepy skin, surface varicose veins, thickening and hardening of the skin on the legs and ankles, and a wound or ulcer that is slow to heal. The varicose veins guide and the leg swelling guide describe overlapping problems.

Why it develops

MedlinePlus says chronic venous insufficiency is most commonly due to malfunctioning valves in the veins, and it can also follow a past blood clot in the legs. Risk factors include age, family history, female sex, past deep vein thrombosis, obesity, pregnancy, sitting or standing for long periods and tall height. Some of these cannot be changed, but weight and activity can, as the obesity and BMI guide explains. The condition tends to get worse over time.

Rule out the dangerous look-alikes

Not all leg swelling is venous. A clot in a deep vein causes sudden swelling, pain and warmth, usually in one leg, as the leg blood clot warning signs guide explains. Narrowed leg arteries cause pain with walking, covered in the peripheral artery disease guide. Heart, kidney or liver problems can also swell both legs, and the heart failure management page explains one of those. A provider sorts these out first.

How it is diagnosed

According to MedlinePlus, the diagnosis is often made from the appearance of the leg veins when you are standing or sitting with the legs dangling, along with a physical exam and your history. A duplex ultrasound of the leg may be ordered to check how blood flows in the veins and to look for a clot, and it is arranged by referral because the practice does not list it. Blood work is offered to look for other causes of swelling.

Self-care and treatment

The encyclopedia advises not sitting or standing for long periods, moving the legs to keep blood flowing, caring for any sores, losing weight if overweight and exercising regularly. Compression stockings gently squeeze the legs and help prevent swelling. More advanced options such as sclerotherapy, laser or radiofrequency treatment, glue or foam, or surgery are done by vein specialists, not in this office. The slow-healing wounds guide covers ulcers.

When to be seen quickly

MedlinePlus advises contacting a provider for painful varicose veins, a condition that worsens despite self-care, sudden increased leg pain or swelling, fever, redness of the leg or leg sores. Redness, warmth and fever can mean infection, as the cellulitis guide explains. Call 911 for chest pain, sudden shortness of breath or coughing blood, which can be a clot in the lung, described in the pulmonary embolism guide.

Sources

• MedlinePlus: Venous insufficiency (encyclopedia)