OH, MY ACHING LEGS

Chronic venous insufficiency (CVI) is a medical condition affecting the veins, especially in the lower limbs when the blood no longer circulates back to the heart effectively. The disease starts with a variety of symptoms but remains largely unknown despite the potentially severe complications that can arise.

CVI is common: Up to 20 per cent of adults might be affected. By age 50, nearly 40 per cent of women and 20 per cent of men have significant problems in their leg veins. Anyone with a family history of varicose veins or who's had multiple pregnancies or must often stand around for long periods is prone to CVI.

The recurrent symptoms include "heavy legs", restlessness, fatigue, pain, swelling, muscle cramps and itching in the legs. The most common sign is a swelling in the ankles or whole feet that progresses to the lower legs.

The skin might redden or otherwise become discoloured, and there can be eczema, varicose and spider veins and, later on if untreated, venous leg ulcers. In advanced cases, blood clots can occur, a condition called superficial phlebitis or superficial venous thrombosis.

The most severe form of venous diseases, although beyond the scope of CVI per se, is the blood clot called deep vein thrombosis. If the clot breaks free from the vein wall, moves to the heart and becomes stuck in a pulmonary artery, there could be an abrupt interruption of blood flow to a part of the lung.

This is called pulmonary embolism, which can be life-threatening.

Pulmonary embolism is one of the most frequent medical emergencies observed after long haul-flights, during which prolonged sitting causes a deep vein clot to form in predisposed individuals.

CVI is primarily diagnosed by simple physical examination. In some cases an ultrasound of the veins - a venous duplex ultrasound - is needed to assess the blood flow and get an accurate diagnosis of the lesions.

There are many treatment options. First, avoid prolonged standing because it will increase the venous pressure in the legs and trigger more intense symptoms. Walk frequently to strengthen the calf muscles and thus the blood flow. Wear prescription stockings to reduce leg swelling.

Among medications, most topical steroid creams provide temporary relief of skin disorders. The only oral medication that has proved to reduce leg swelling and pain and heal ulcers is the "micronised purified flavonoid fraction preparation", with micronised diosmin being the main medicine used by both doctors and surgeons. Non-micronised flavonoids have shown no benefits.

When not treated early, symptoms will worsen. In advanced stages, a surgeon who specialises in venous diseases will propose an approach that could be conservative (stockings, medications), minimally invasive (sclerotherapy or injection of a solution to collapse the affected veins, laser or radio-frequency treatments) or invasive (surgery with vein stripping and ligation).

Obesity, limited physical activity and high blood pressure have been linked to CVI, so a healthy lifestyle at the right weight and regular exercise is once again the chief preventive measure.

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.