Venous Insufficiency and Varicosities: Overview and Risk Factors

Chronic venous insufficiency is a common clinical problem, whose presentation ranges from mildly unsightly veins to recurrent cellulitis and ulceration requiring frequent hospitalizations. An estimated 25% of the U.S. adult population has some degree of varicose veins, and up to 5% have advanced chronic venous insufficiency and venous ulceration.

The venous system of the lower extremities is composed of deep veins that lie within the muscular compartments and superficial veins that lie outside the deep fascia and muscles. Venous insufficiency is a disorder of the deep veins, whereas varicose veins, the most common manifestation of chronic venous disease, are a disorder of the superficial veins.

Although the underlying etiology is not fully understood (genetic, hormonal, and environmental factors have been postulated), these disorders result from chronic venous hypertension, which can be caused by incompetence of the venous valves, obstruction to venous flow, and/or failure of the muscular “venous pump” (the pumping effect that occurs upon contraction of leg muscles during walking and other activities).

Most cases of varicose veins are asymptomatic. However, clinical symptoms may include swelling, aching, tension, leg fatigue, burning, and pruritis, which are relieved with recumbency or leg elevation. As venous insufficiency progresses, skin pigmentation and induration occur. In severe cases, recurrent cellulitis and ulceration can develop, which may be life–threatening.

Risk Factors

The following factors are associated with increased risk of venous disorders:

• Family history. There is as much as a 90% risk of developing varicose veins if both parents have varicose veins, but less than a 20% risk if neither parent is affected.
• Female gender. Varicose veins occur up to twice as often in women.
• Increasing height.
• Increasing age.
• History of leg injury.
• History of phlebitis or deep venous thrombosis.
• Lifestyle factors. Obesity, prolonged standing, sedentary lifestyle, and pregnancy are suspected risk factors for the development of varicose veins. Physical inactivity is associated with risk for chronic venous insufficiency and varicose veins in some,^1,2 although not all,³ studies. Occupations that require prolonged standing are associated with greater risk.⁴
• Klippel–Trenaunay–Weber syndrome. This condition occurs due to an abnormal or absent deep venous system and results in a triad of extensive unilateral varicose veins, limb hypertrophy, and a port–wine stain.