Have you ever experienced this? After a busy day, your legs feel as heavy as lead, your ankles swell like little buns, and thin 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)!
Imagine your leg veins as highways, responsible for transporting blood from your legs back to your heart.
Under normal circumstances, these “highways” have a series of one-way valves, acting 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.
What are the Lower Limb Veins?
Lower Limb Veins
But if these valves fail, or the pump is not strong enough, blood will stagnate in the legs like traffic congestion. At this point, the pressure in the veins is like rush-hour traffic, increasing steadily and gradually expanding the veins, leading to a series of problems.
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.
Why Does “Congestion” Occur?
✅ 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 vein dilation, valve failure, blood reflux, and ultimately, the development of Chronic Venous Disease.
The symptoms of Chronic Venous Disease are like a “gradual crisis,” varying from mild to severe:
What are the Typical Symptoms?
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: thin blue veins, spreading 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 Prolonged blood stagnation leads to skin turning brown or reddish-brown, accompanied by itching, dryness, rash, or oozing. Severely, the skin may harden, forming scar-like changes(lipodermatosclerosis).
“Volcano” 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 seeking medical attention, 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, thrombosis, or family history.
✅ Physical Examination Observe whether there are varicose veins, edema, skin pigmentation, or ulcers on the legs.
✅ Imaging Examination Ultrasound:
Other Imaging or Interventional Examinations:
02 CEAP Grading System To scientifically assess the severity of Chronic Venous Disease, doctors use the CEAP grading system(Clinical-Etiology-Anatomy-Pathophysiology):
Gold Standard Examination, assesses venous blood flow, valve function, and the presence of deep vein thrombosis. Can differentiate between superficial and deep venous issues.
such as venography or CT/MRI venography, used for complex cases, clearer imaging, but higher cost and greater radiation exposure.
Clinical Grading(C) ● C0: No visible venous disease; ● C1: Telangiectasias 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, deep, or perforating veins.
Pathophysiology(P): ● Reflux, obstruction, or both.
The CEAP grading helps doctors to formulate precise treatment plans. For example, stage C1 may only require observation, while stage C6 requires active intervention.
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: Toe raises, ankle flexion and extension, or walking for 30 minutes daily activate the calf muscle pump, equivalent to installing a “turbocharger” on the veins. Particularly suitable for those who stand or sit for long periods.
How to Improve?
2. Compression Therapy ✅ Medical compression stockings: Provide gradient pressure(highest at the ankle, decreasing upwards), preventing blood reflux. 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 may require heavy compression or custom stockings.
The Right Way to Wear Compression Stockings👇🏻 Choose the Right Time: Morning is best for putting on stockings when leg edema is at its lightest. Correct Method of Wearing (“Heel Flap 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, 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 and air dry daily, and have two pairs to alternate use. Special Cases: If you have difficulty wearing them, consult your doctor for a stocking aid or choose a different style (such as open-toe).
✅ Intermittent Pneumatic Compression Pump(IPC): Suitable for severe edema or obesity ✅ Compression Bandages: Used for ulcer patients, applied by professionals in multiple layers of elastic bandages(e.g., Unna boot), changed 1-2 times a week, must be kept dry. 3. Ulcer Care Venous ulcers require special dressings (e.g., hydrogel or foam dressings) to absorb exudate and promote healing, best paired with compression therapy.
4. Medication Assistance ✅ Improving Edema:Micronized flavonoids (500 mg, 2 times/day), can improve edema and symptoms. ✅ Topical Treatment: Venous eczema can be treated with
02 Surgical and Interventional Treatment Indications for surgery: ● Severe symptoms(such as C3-C6) affecting quality of life; ● Conservative treatment (e.g., compression therapy) failure; ● Complications such as recurrent ulcers, phlebitis, or bleeding.
patients, the device periodically inflates to compress the legs, promoting blood flow. Use for several hours a day for significant effects.
low-potency corticosteroid ointments(e.g., hydrocortisone), avoid antibiotic ointments or fragranced lotions to prevent allergies.
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, redirecting blood to healthy “alternate routes,” 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; ● Perforator vein treatment.
Will Surgery Hurt? Is General Anesthesia Needed?
Vein surgery typically uses 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, without the risks of general anesthesia, and recovery after surgery is faster.
⚠️ Postoperative注意事项： ● Postoperatively, wear compression stockings for 1-2 weeks to promote blood flow;
● Avoid prolonged standing and moderate activity;
● Regular follow-ups to monitor the risk of recurrence (post-thrombotic syndrome, etc.).
Prevention of Lower Limb Varicose Veins
The treatment of Chronic Venous Disease requires a lot of patience, and prevention in daily life is also very important. Here are some tips for everyone: ✅ Move: Avoid prolonged standing or sitting, move around for 5-10 minutes every hour. ✅ Control Weight: Reduce the burden on leg veins. ✅ Regular Check-ups: Those with family history or early symptoms, consult a vascular specialist as soon as possible for assessment. ✅ Avoid Myths: Don’t use anti-itch cream or fragranced lotions, which may cause contact dermatitis.
If symptoms worsen or ulcers appear, do not delay, consult and treat promptly, surgical intervention may be necessary. After all, healthy legs can take you everywhere!
