Venous disease, affecting the venous system, is one of the most common maladies to affect the legs of people and to negatively impact their quality of life. Mild forms present cosmetic concerns with the more severe forms resulting in serious symptoms significantly reducing the quality of life, mobility and productivity. The recently published Bonn study reported just over 90% of the population has some level of venous disease with 17% experiencing the more severe levels.
Venous disease presents in two main categories – chronic venous insufficiency or venous thromboembolisms (blood clots).
Chronic venous insufficiency (CVI) is marked by a failure of valves in the vein to function properly, resulting in stasis of blood and ambulatory venous hypertension over an extended period of time. However, there are transient occurrences of venous insufficiency such as during pregnancy, which often reverse following the pregnancy. The most common presentation of venous disease is telangiectasias (spider veins) found in 60% of the population and varicose veins, which affect over 14% of the population. The more severe presentations are swelling (edema), skin discoloration and ulceration.
Reflux occurs when valve malfunction allows backflow in veins. The pump function is ineffective. Veins stay full, valves don't close, and pressure in the veins remains abnormally high (venous hypertension).
Valve malfunction can be congenital (when a person is born with it), which is rare; or acquired. Valve malfunction can be acquired different ways:
Weak vein walls or valves can give way under "normal" stresses.
High pressures or prolonged pressure (e.g. people who stand in one place without moving for prolonged periods) can stretch vein wails so valves don't work.
Valves can become damaged from obstructions in the veins (blood clots)
Venousthromboembolism (VTE) is the formation of blood clots in the venous system and is comprised by Deep Vein Thrombosis (DVT), which are clots in the deep veins of the legs and torso affecting over 600,000 in the USA each year and Pulmonary Embolism (PE) clots found in the lungs. PE is a life threatening condition resulting in over 100,000 deaths per year in the USA alone.
These clots will typically resolve themselves over time, however many develop into a chronic condition developing into permanent obstructions in the veins, which result in valve damage and hypertension. This condition is known as Post Thrombotic Syndrome (PTS).