Do you have concerning swelling in your legs? You may have venous stasis

A patient of mine came in last week suffering from swelling and pain in his legs. He was suffering from a problem that is becoming more common – pooling of blood in his legs causing unsightly enlarged veins.

To understand how vein problems develop you need a rudimentary understanding of the anatomy and physiology of the vascular system. Fresh blood that contains oxygen and nutrients is pumped from the heart to the legs via arteries. The blood then moves through very tiny blood vessels called capillaries where the oxygen and nutrients move out of the blood into the surrounding tissues. Waste products and carbon dioxide then move from the tissues into the capillaries and then into veins for the trip back up to the heart and eventually to the lungs, liver and kidneys where the waste products are removed from the body.

Venous blood has a hard time moving against gravity from the legs to the heart (unless you stand on your head). To get around this problem, the body utilizes two nifty mechanisms. The first is the contractions of the muscles in the legs that push the blood upward like squeezing toothpaste out of a tube. The second is one-way valves that prevent venous blood from moving back down toward the feet.

When you understand how the physiology of venous blood flow works, it makes it easier to understand how things can go awry. Gravity is the major obstacle to overcome. People who stand all day long are battling the force of gravity as it constantly pulls the blood back toward the feet. This is why our feet tend to swell as the day progresses. Obese individuals are more likely to develop problems since their weight puts additional force on the blood in their veins causing even more downward pressure and swelling.

People who are inactive also tend to have more problems. Since they are not walking around, they don’t receive the benefit of muscular contractions to squeeze the blood upward.

Gravity causes our veins to enlarge as we age. When this occurs, the valves in the veins no longer meet to stop the downward flow and they become leaky (see diagram). This results in more blood pooling in the leg veins causing more dilation and more leaking – a vicious cycle leading to unsightly varicose veins.

Pooling of blood in the legs is called venous stasis. The blood can’t move upward to have the waste products removed and the leg tissues, especially the skin, become unhealthy and start to break down. This can lead to rashes and itching called “stasis dermatitis” as well as ulcer formation and infections that can sometimes be very serious.

Treatment of venous stasis can be very difficult depending on the how advanced the problem is at the time a patient presents to a medical provider. Sometimes the dilated veins need to be tied off or surgically removed. Some veins can be closed by injecting them with solutions to scar them closed.

Less severe cases of venous stasis can usually be treated with compression stockings and elevating the feet above the level of the heart. The stockings provide a compressive force to counteract gravity. People who have developed rashes and ulcers may need to have medicated dressings. Response to treatment can be slow and may require referral to a specialized wound care center. Serious infections may require antibiotics and surgery. Diuretics (water pills) are not very effective at treating the root cause.

The best way to treat venous stasis is to prevent it in the first place. People who spend a lot of time on their feet or take long trips in planes, trains or automobiles should walk frequently or do calf pumps or toe raises to help pump the blood out of the legs. They should also consider elevating the legs above the level of their chest on their breaks and after work. If they can’t walk, they should wear compression stockings during their work shift. Good hydration is very important to keep the blood from becoming too thick that may lead to blood clot formation.

Obese people with venous stasis must work hard on weight loss in addition to the prevention strategies above. I would be remiss if I did not mention that smoking also greatly increases the risk for developing vein deterioration and slows healing. It also greatly increases the risk for tissue breakdown, ulcer formation due to decreased oxygen delivery, and promotes the formation of blood clots.