Venous insufficiency is a very common chronic disease: there are 18 million venous insufficiencies in France, or nearly one in three people. Without treatment, it is impossible to escape the progression of the disease and the worsening of symptoms: heavy legs are accompanied by varicose veins and can eventually lead to many complications. However, only 30% of patients are treated. Many of them are unaware of being affected by this disease, which can occur from the start of adulthood and which affects women first (they represent 75% of the sick), even if the disease also affects men.
Given the scale of untreated cases – around 12 million people – the need for better prevention is crucial since, on average, 7 years separate the first symptoms from the first consultation. Above all, venous insufficiency is a disease whose course and complications are inevitable without appropriate and regular treatment. It has 7 clinical stages. Detailed review of these different stages with Doctor Vincent Crébassa, vascular doctor and phlebologist in Montpellier.
“Spider veins mark entry into venous disease”
At the first stage, no varicose or varicose veins are visible. According to Vincent Crébassa, “the person only has symptoms like pain, heaviness and tingling in the legs, as well as night cramps ”. He adds that she “can sometimes feel a grip around the ankle, especially at the end of the day ”. The attending physician can offer so-called veinotonic drugs which act on the vein and reduce pain.
The second stage is the appearance of the first spider veins. “This stage marks the entry into venous disease ”, explains Vincent Crébassa. To limit their development, we can use compression stockings or sclerotherapy. These are injections of sclerosing products into the vein to close it.
100,000 phlebitis each year in France
The transition to the third stage occurs when varicose veins appear. “These are veins whose caliber measures more than 3 mm ” specifies Dr Crébassa. They are due to the loss of elasticity of the veins, which will then thicken and dilate. The blood stagnates at the level of the vein, this is called venous stasis. Varicose veins are therefore not just an aesthetic problem.
A few years ago, the most common treatment was surgery, but today there is more use of sclerotherapy, endovenous laser and the Closure method, the latter two burning the inside of the vein. Despite these treatments, varicose veins can reappear.
During the fourth stage, the stasis eventually accumulates in the tissues until creating venous edema. “It is characterized, specifies Vincent Crébassa, by swelling of the ankle and lower third of the leg ”. Edema is mainly relieved by compression stockings.
The next stage leads to a first skin complication with the onset of trophic disorders. “The skin has trouble regenerating and suffers, which causes varicose eczema and ocher dermatitis ”, explains the vascular doctor. The latter is called in reference to the color of the skin when blood comes out of the varicose vein. Hypodermitis, more serious, corresponds to an inflammation of the tissues under the skin, which then becomes very fragile when faced with the slightest shock.
In the sixth stage, venous ulcers arise. “They can be caused by a simple shock and whose healing is difficult ”, warns Vincent Crébassa. When open, the ulcer requires the application of bandages.
The seventh and last stage is that of serious complications : varicose hemorrhage (varicose vein which ruptures and bleeds heavily), phlebitis and pulmonary embolism. “Even if not all pulmonary embolisms are due to varicose veins, the latter aggravate and trigger phlebitis more easily, which can subsequently cause pulmonary embolism ”, alerts the practitioner. In France, 100,000 cases of phlebitis are reported each year, while pulmonary embolism causes 10,000 deaths per year. It is the risk of reaching this stage for lack of good management that makes venous disease a health problem that should not be overlooked.