Best treatments for venous stasis

What Is Venous Stasis?

To understand venous stasis, it's helpful to know how blood normally circulates in the legs. Veins carry blood back to the heart, working against gravity. To keep blood moving upward, leg veins have one-way valves that open to allow blood to flow toward the heart and close to prevent it from flowing backward.

In venous stasis, these valves are weakened or damaged, often because of age, obesity, or previous blood clots. When the valves don't function the right way, blood can leak back down the vein and pool in the lower leg. This raises pressure in the veins, causing a condition called venous hypertension.

Over time, this increased pressure can make fluid leak from the veins into the tissues around them. This causes swelling, skin changes, and other symptoms of CVI. The condition often progresses through several stages:

1. Spider veins or reticular veins: small, damaged veins visible under the skin
2. Varicose veins: larger, twisted, rope-like veins
3. Edema: swelling due to fluid buildup in the tissues
4. Skin changes: discoloration, thickening, or itching of the skin
5. Venous stasis ulcers: open sores, usually around the ankles

Complications like ulcers can be painful and difficult to heal, sometimes causing infection. It’s important to diagnose and treat venous stasis early, before serious problems develop. Treatment focuses on reducing pressure in the veins, improving circulation, and preventing complications.

Common Symptoms of Venous Stasis

The symptoms of venous stasis can vary from person to person and may worsen over time if the condition is not treated. Some of the most common signs and symptoms include:

• Swelling in the legs and ankles, especially after standing or sitting for long periods
• Aching, heaviness, or cramping in the legs, particularly at the end of the day
• Itching or tingling sensations in the legs
• Visible spider veins or varicose veins
• Skin changes, such as discoloration, thickening, or flaking
• Slow-healing wounds or sores on the legs, known as venous stasis ulcers

Leg swelling, or edema, is usually worse at the end of the day and may get better overnight or with leg elevation.

As venous stasis progresses, your skin might start to change. It may look reddish-brown as hemosiderin builds up, a pigment from broken-down red blood cells. The skin may also get thicker, drier, or itchier than normal.

In advanced stages of venous stasis, open sores called venous ulcers can develop around the ankles. These ulcers are painful and slow to heal. They happen when the higher pressure and fluid buildup damage the skin and tissues underneath, making them more prone to injury and infection.

Other symptoms venous stasis may cause include restless legs, burning sensations, and muscle cramps, especially at night. The severity of symptoms can vary depending on the extent of valve damage, the degree of venous hypertension, and other health conditions.

It's important to seek medical attention if you have persistent symptoms of venous stasis. Early diagnosis and treatment can help with discomfort and prevent the condition from getting worse. Your healthcare provider can assess your symptoms, perform diagnostic tests, and recommend an appropriate treatment plan.

Lifestyle Changes To Manage Venous Stasis

Certain lifestyle changes can help manage symptoms and prevent complications. These self-care habits can help improve circulation, reduce swelling, and keep your legs healthy:

• Regular exercise: Activities that engage the calf muscles, such as walking, cycling, or swimming, can help pump blood back to the heart and reduce pooling in the legs. Try to get at least 30 minutes of moderate exercise most days of the week.
• Elevate your legs: Raising your legs above the level of your heart for 15-30 minutes a few times a day can also help reduce swelling and improve blood flow. You can do this by lying down and propping your legs up on pillows or using a recliner chair. Try to make leg elevation a regular habit, especially at the end of the day.
• Wear compression stockings: These special socks apply graduated pressure to the legs, with the most pressure at the ankle gradually decreasing up the leg. This helps push blood back up toward the heart and reduces pooling and swelling. Compression stockings come in different lengths and compression levels.
• Maintain a healthy weight: Excess weight puts added pressure on the veins and can worsen symptoms. Eating a balanced diet rich in fiber, fruits, and vegetables can help with weight management and give you nutrients important for vein health, like vitamin C and flavonoids.
• Avoid prolonged standing or sitting: If your job requires long periods of standing, try to take frequent breaks to walk around or flex your calf muscles. When sitting for long periods, such as during travel, get up and move around every hour or so and consider wearing compression stockings.
• Proper skin care: Keeping the skin moisturized can help prevent dryness, itching, and cracking that causes ulcers. Use a gentle, fragrance-free moisturizer daily, and avoid hot baths or showers which can dry out the skin.
• Protect your legs from injury: Even minor scrapes can develop into hard-to-heal wounds in advanced stages of venous stasis.

Some people with venous stasis find relief with practices like yoga, massage, or aromatherapy. Gentle yoga poses that elevate the legs, such as legs-up-the-wall pose, can help improve circulation. Massage techniques like manual lymphatic drainage can help reduce swelling. Using essential oils like cypress, grapefruit, and geranium in massage blends or baths may help circulation. Always check with your healthcare provider before starting any new complementary therapy.

Compression Therapy for Venous Stasis

Compression therapy is the main treatment for venous stasis and related conditions. External pressure is applied to the legs to improve blood flow, reduce swelling, and help symptoms. The main goals of compression therapy are to help heal venous ulcers, reduce pain and edema, and prevent these problems from coming back.

Compression works by gently squeezing the leg tissues and walls of the veins, helping to narrow the veins and restore the function of the valves. This reduces venous reflux, the backward flow of blood, and lowers the pressure in the veins. By improving circulation, compression also helps lower inflammation, raise the flow of fluid and nutrients in the smallest blood vessels (capillaries), and help your body break down blood clots.

There are several types of compression therapy, including:

• Compression bandages: Compression bandages are usually applied by a healthcare provider and can be inelastic (short-stretch) or elastic (long-stretch). Your provider will help you choose which one is right for you.
• Stockings: Compression stockings are a widely used option that applies graduated pressure, with the highest pressure at the ankle gradually decreasing up the leg. They come in different compression levels, typically ranging from 15-20 mmHg for mild compression to 40-50 mmHg for severe cases. It's important to get properly fitted for compression stockings by a healthcare provider to make sure they provide the right level of compression and fit comfortably.
• Pneumatic compression devices: Pneumatic compression devices use an air pump to inflate and deflate a sleeve around the leg, intermittently applying pressure to improve blood flow. These devices can be used at home or in a healthcare setting and may be helpful for people who have trouble wearing compression stockings.

While compression therapy is generally safe, there are some people it is less appropriate for. People with severe peripheral artery disease, heart failure, or less feeling in their legs should typically not use compression. It's important to watch the skin for any signs of irritation, breakdown, or reduced circulation and to adjust the level of compression as needed.

Compression garments must be put on properly to work. Compression stockings, for example, should be put on first thing in the morning and worn the whole day. They should be replaced every 3-6 months or sooner if they start to lose elasticity or get holes. Following the manufacturer's washing and drying instructions can help them last longer.

Sticking to compression therapy can sometimes be difficult, as some people find the garments uncomfortable or difficult to put on. However, there are many things you can do to help you stick with it, like using aids to put them on (donning aids), choosing comfortable materials like cotton-lined stockings, and gradually increasing the time you wear them for. Setting reminders, getting help from a caregiver, and tracking your progress can also help you make compression therapy a consistent habit.

While compression therapy is an important part of treating venous stasis, it works best as part of a comprehensive management plan that also includes lifestyle changes, medications, and other treatments. Working closely with a healthcare provider who specializes in venous conditions can help you get the best and most personal care.

Medications for Venous Stasis

Medications can also play an important role in managing venous stasis. Medications can help improve symptoms, encourage healing, and prevent complications caused by chronic venous insufficiency. Some of these medications are:

• Anticoagulants (blood thinners): These drugs help prevent blood clots, which can be a serious complication of venous stasis. By making it harder for blood to clot, anticoagulants can improve circulation and lower the risk of deep vein thrombosis (DVT).
• Common anticoagulants used to treat venous stasis include heparin, warfarin, and newer agents like apixaban and rivaroxaban.
• Topical medications: These are used to heal venous stasis ulcers. These medications can reduce inflammation, fight infection, and stimulate new tissue growth. Topical antibiotics may be prescribed if an ulcer gets infected, while topical corticosteroids can help reduce inflammation and itching. Collagenase ointment helps remove dead tissue from the wound, and becaplermin gel contains a growth factor that promotes healing.
• Vasodilators: These are used to improve circulation in the legs. These drugs work by relaxing and widening the blood vessels, which allows blood to flow more easily. Pentoxifylline is a common vasodilator used to treat venous stasis. It helps improve blood flow and oxygenation in the microcirculation, the smallest blood vessels in the body.
• Supplements: Horse chestnut seed extract contains a compound called aescin that may improve venous tone and reduce inflammation. Diosmin and hesperidin, found in citrus fruits, may help improve venous circulation and reduce swelling. However, it's important to talk to your healthcare provider before starting any new supplement, as they can interact with other medications.

When considering medications for venous stasis, it's important to have a comprehensive discussion with your healthcare provider about the potential benefits, risks, and side effects. Your provider will consider factors like how severe your condition is, your overall health, and any other medications you're taking to choose the most appropriate treatment plan for you.

Regular follow-up with your healthcare provider is important to monitor your response to treatment and to make any changes. Your provider may recommend periodic blood tests or imaging studies to see how well your medications are working and to check for any potential side effects or complications.

In addition to medications, your healthcare provider may also recommend other treatments for venous stasis, such as endovenous laser therapy or sclerotherapy, which closes off damaged veins to redirect blood flow to healthier veins. These procedures can help reduce symptoms and prevent complications, but they may not be right for everyone.

Conclusion

Venous stasis is a common condition that can cause significant discomfort and lead to serious complications if left untreated. There are many treatments available to help you improve your condition.

Ultimately, the most effective approach to managing venous stasis is a comprehensive one that combines lifestyle changes, compression therapy, and medications as needed. By working closely with your healthcare provider and taking an active role in your own care, you can successfully manage your symptoms and reduce your risk of complications.

Citations: