Venous insufficiency is a common cause of leg pain and swelling. It is a condition that occurs when vein walls lose elasticity and/or the effectiveness of the one-way valves is reduced. This results in a backflow of blood and pooling in the veins.

Venous insufficiency most commonly manifests as varicose veins, swollen and aching legs, skin changes or leg ulcers. It is quite common for patients to have venous insufficiency without having visible signs of varicose veins.

It is possible for patients to have Venous insufficiency alone, Venous insufficiency associated with varicose veins, or varicose veins without Venous insufficiency.
 

CEAP classification

In order to assist with classifying the varying degrees of venous insufficiency, the CEAP clinical classification system was introduced in 1994.

This acronym stands for:

• Clinical – what the patient’s veins look like
• Etiology – whether the problem is inherited or not
• Anatomy – which veins are involved
• Pathophysiology – in which direction the blood is flowing (either normal or abnormal flow) and whether blood flow is blocked

This system ensures universal standardisation of identifying and treating disorders associated with venous insufficiency.

The CEAP clinical classification system uses a combination of four factors: severity, cause, location and specific abnormality and consists of the following seven grades:
C0 – No evidence of venous disease
C1 – Superficial spider veins (reticular veins) only
C2 – Simple varicose veins only
C3 – Ankle oedema of venous origin (not foot oedema)
C4 – Skin pigmentation in the gaiter area
C5 – A healed venous ulcer
C6 – An open venous ulcer

The following risk factors can contribute to Venous Insufficiency:

• Family history of Venous Insufficiency
• Family history of Deep Vein Thrombosis in the legs
• Age – more common among older people
• Height – being tall means the veins have to work harder
• Being female – higher levels of the hormone progesterone can act as a muscle relaxant, hindering the muscles pumping ability
• Obesity – increased pressure on the body
• Pregnancy – increased hormone levels and increased pressure on the body
• Sitting or standing for long periods of time – increased pressure due to gravity