Chronic venous disease is a common disorder that affects the veins of the legs. Vein disease happens when the veins in the legs do not work the right way. Normally, the veins in the legs carry blood from the legs back to the heart. The veins have tiny valves inside them to help keep blood moving in only one direction (towards the heart). The valves open to let blood flow to the heart, and close to keep it from flowing back down the leg. Vein disease can happen when the valves are damaged or do not work well. This causes blood to collect in the legs. Blood is especially likely to collect in the legs when people sit or stand for a long time without walking. There are several conditions that can cause the valves and veins to work improperly. A blood clot in a leg vein or leg injury can lead to damage of these valves of the veins causing venous disease Increased body weight (for example, pregnancy, obesity) can increase pressure in the veins of the legs, and this can damage the veins and valves, and vein disease can also run in families. People with vein disease can have different symptoms. The most frequent feature of venous disease is widening of the veins. Widened veins may appear as thin blue flares (shape of spider) to much wider veins that appear as twisted and raised areas on the skin (called varicose veins). Long-standing venous insufficiency can cause swelling (edema) in the ankles and lower legs. Mild edema may only be found at the end of the day or it may be present all the time. The area around the ankle bones is often the first place that the swelling is seen. However, there are many other causes of swelling, hence the need for proper medical check up to determine the specific cause. The skin can turn red or red-brown with skin colour changes often happening first around the ankle. There can also be appearance of wounds, also called “venous ulcers” that usually happen at the ankle and can be painful and oozing. These venous ulcers can recur or may not heal for months or years. The diagnosis of chronic venous disease can be made based upon one’s symptoms. Further testing (ultrasound scan) is often performed to look at vein valve function to identify if the problem is located in the superficial veins or the deep veins of the veins. Treatment of chronic venous insufficiency tries to reduce symptoms, edema (swelling), treat thickened, hardened tissues, and heal ulcers. Simple elevation of the legs above heart level for 30 minutes three or four times per day can reduce edema and improve blood flow in the veins. Improving blood flow can speed healing of venous ulcers. Leg elevation alone may be the only treatment needed for people with mild venous disease, although additional treatments are usually needed in more severe cases. Foot and ankle exercises are often recommended to reduce symptoms. Pointing the toes and feet down and up several times throughout the day can help to pump blood up into the legs. This may be especially helpful for people who sit or stand for long periods. Some patients may be prescribed compression therapy to be an essential treatment for chronic venous disease. Compression stockings are suggested for anyone with chronic venous disease. People with more severe symptoms, such as severe edema, skin changes, or skin ulcers, often need treatment with compression bandages. Ulcers are usually covered with special dressings before putting on compression stockings or compression bandages. Dressings are used to absorb fluid oozing out of the wound, reduce pain, control odor, remove dead or infected cells, and help new skin cells to grow. A variety of medications have been used for chronic venous disease and venous ulcers and these are prescribed according to one’s symptoms. Dr. Ian Shyaka , Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com
