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Have you ever experienced this? After a busy day, your legs feel as heavy as lead, your ankles swell like little buns, and there are small blue veins spread across your skin like a spider web? This may be your leg veins “going on strike”!
Today, let’s talk about this common yet often overlooked issue—Chronic Venous Disease(CVD)!
What are the lower limb veins?
Imagine that the veins in your legs are like highways, responsible for transporting blood from your legs back to your heart.
Under normal circumstances, these “highways” have a series of one-way valves, like traffic police, ensuring that blood flows only towards the heart. The muscles in your legs(especially the calf muscles) act as a powerful pump, giving a “push” every time you walk or move, helping blood to go against gravity.
Lower limb veins
But if these valves are damaged, or the pump is not strong enough, blood will stagnate in the legs like traffic congestion. At this time, the pressure in the veins is like rush-hour traffic, increasing and gradually expanding the veins, leading to a series of problems.
Why does “congestion” occur?
There are various reasons for venous “traffic congestion”:
✅ Deep vein thrombosis(DVT): Blood clots act as barriers, blocking blood flow, increasing venous pressure, and even permanently damaging valves.
✅ Leg trauma or surgery: Trauma or surgery may destroy venous pathways or valve function.
✅ Overweight: Obesity or pregnancy increases the burden on leg veins, doubling the pressure.
✅ Prolonged standing/sitting: Lack of movement means leg muscles cannot effectively “pump blood,” leading to blood stagnation.
✅ Genetic factors: Family history may increase the risk of congenital defects in vein walls or valves.
✅ Other factors: Conditions such as chronic venous inflammation or congenital venous malformations may also cause issues.
These factors lead to venous dilation, valve failure, blood reflux, and ultimately, the development of chronic venous disease.
What are the typical symptoms?
The symptoms of chronic venous disease are like a “gradual crisis,” varying from mild to severe:
Mild symptoms
Heavy, aching, and tired legs, especially noticeable after a day of standing, as if dragging a big sandbag on your legs.
Venous dilation
👉 Spider veins: small blue veins, spread across the skin like a spider web.
👉 Varicose veins: Thick, twisted veins, protruding like earthworms on the skin.
Edema
Swelling of the ankles and lower limbs, more noticeable in the evening, possibly relieved in the morning.Early stages often appear above the ankle.
Skin changes
Long-term blood stagnation leads to skin turningbrown or reddish-brown, accompanied by itching, dryness, rash, or oozing. Severely, the skin may harden, forming scar-like changes(lipodermatosclerosis).
“Volcano mouth” warning
The most severe manifestation, known as ” venous ulcers” or “stasis ulcers“. Commonly seen on the inner ankle, they appear as superficial, red-based, irregularly edged, often oozing, slow to heal(months or even years), and prone to recurrence.
Diagnosis and Grading
After a medical consultation, doctors will diagnose and grade according to the following steps:
01 Diagnosis
✅ Medical history
Doctors will ask if you have symptoms such as leg heaviness, swelling, skin changes, or ulcers, and whether you have a history of prolonged standing/sitting, blood clots, or family history.
✅ Physical examination
Observe whether there are varicose veins, edema, skin pigmentation, or ulcers on the legs.
✅ Imaging examinations
Ultrasound:Gold standard examination, assesses venous blood flow, valve function, and the presence of deep vein thrombosis. Can differentiate between superficial and deep venous issues.
Other imaging or interventional examinations:Such as venography or CT/MRI venography, used for complex cases, clearer imaging, but higher cost and greater radiation exposure.
02 CEAP classification system
To scientifically assess the severity of chronic venous disease, doctors use the CEAP classification system (Clinical-Etiology-Anatomy-Pathophysiology):
Clinical classification(C)
●C0: No visible venous disease;
●C1: Spider veins or reticular veins;
●C2: Varicose veins;
●C3: Edema;
●C4a: Pigmentation or eczema;
●C4b: Lipodermatosclerosis or atrophie blanche;
●C5: Healed venous ulcer;
●C6: Active venous ulcer.
Etiology(E)
●Primary(congenital or degenerative), secondary(post-thrombotic syndrome), or congenital.
Anatomy(A):
●Superficial veins, deep veins, or perforating veins.
Pathophysiology(P):
●Reflux, obstruction, or a combination of both.
The CEAP classification helps doctors to formulate treatment plans precisely. For example, stage C1 may only require observation, while stage C6 requires active intervention.
How to improve?
The treatment goal for chronic venous disease is to relieve symptoms, reduce edema, prevent complications(such as ulcers) and improve quality of life. Here is a comprehensive strategy from conservative to surgical treatments:
01 Conservative treatment
1. Daily exercises
✅ Elevation method: 3-4 times a day, 30 minutes each time, raise the legs above the heart to allow blood to “flow downstream”. This is especially effective for edema and ulcer healing, but consistency is key to seeing results!
✅ Exercise activation: Standing on tiptoes, flexing and extending ankles, or walking for 30 minutes daily activates the calf muscle pump, equivalent to installing a “turbocharger” on the veins. Especially suitable for people who stand or sit for long periods.
2. Compression therapy
✅ Medical compression stockings: Provide gradient pressure(highest at the ankle, decreasing upward), preventing blood backflow. Available in light(15-20 mmHg), medium(20-30 mmHg), and heavy(30-40 mmHg)compression levels.Patients with C2-C3 often use medium compression, while C4-C6 patients may need heavy compression or custom stockings
.
The correct way to wear compression stockings👇🏻
Choose the right time:morningis best for wearing stockings, as leg edema is minimal.
Correct method of wearing(“HEEL FLIP METHOD”):
1. Turn the stocking inside out, place your foot into the stocking;
2. Grab the folded edge and pull it over your heel;
3. Slowly roll up while keeping it smooth and wrinkle-free.
Tips:Wear rubber gloves for better grip, or sprinkle talcum powder on your legs to reduce friction.
Cleaning and replacement: Wash by hand in cold water daily, and dry in the air, use two pairs in rotation.
Special circumstances: If you have difficulty wearing them, consult a doctor for a stocking aid or choose a different style(such as open-toe type).
✅ Intermittent pneumatic compression pump(IPC): Suitable for severe edema or obesity patients, the device periodically inflates to compress the legs, promoting blood flow. Use for several hours a day for significant effects.
✅ Compression bandages: Used for ulcer patients, applied by professionals in multiple layers of elastic bandages(such as Unna boots), changed 1-2 times a week, must be kept dry.
3. Ulcer care
Venous ulcers require special dressings(such as hydrogel or foam dressings)to absorb exudate and promote healing, best used in combination with compression therapy.
4. Medication assistance
✅ Improve edema:Micronized flavonoid compounds(500 mg, twice a day), can improve edema and symptoms.
✅ Local treatment: Venous eczema can be treated with low-potency corticosteroid ointments(such as hydrocortisone), avoid antibiotic ointments or fragranced lotions to prevent allergies.
02 Surgical and interventional treatments
Indications for surgery:
● Severe symptoms(such as C3-C6) affecting quality of life;
● Conservative treatment(such as compression therapy)has failed;
● Complications such as recurrent ulcers, phlebitis, or bleeding.
When conservative treatments are ineffective or symptoms are severe(CEAP C3-C6), doctors may recommend interventional or surgical treatments to close or remove problematic veins, allowing blood to take a healthy “detour”, including:
● Non-thermal ablation: such as foam sclerotherapy, glue closure, mechanical-chemical ablation;
● Thermal ablation: Radiofrequency ablation(RFA), Endovenous laser ablation(EVLA);
● Vein stripping and ligation;
● Perforating vein treatment.
Will surgery hurt? Is general anesthesia needed?
Vein surgery usually involves a special type of anesthesia:tumescent anesthesia.
Doctors inject a special “cocktail” around the target vein—a mixture of diluted lidocaine(local anesthetic), epinephrine(to constrict blood vessels and reduce bleeding), sodium bicarbonate(to reduce the acidic discomfort during injection), and a large amount of saline solution. The injected solution causes the tissue around the target vein to “swell,” separating the vein from the skin, muscles, and other tissues.
This way, the heat during ablation will not damage surrounding tissues, reducing the risk of burns or nerve damage. Since it is local anesthesia, you remain conscious and do not have to bear the risks of general anesthesia, and recovery after surgery is faster.
⚠️ Postoperative attention is needed:
● Postoperatively, wearcompression stockings for 1-2 weeksto promote blood flow;
● Avoid prolonged standing and moderate activity;
● Regular follow-ups to monitor the risk of recurrence(post-thrombotic syndrome, etc.).
