Since the start of the COVID-19 pandemic, Dr. Danielle Bajakian, vascular surgeon and Director of the Columbia Vein Program, has seen an increasing number of patients with venous insufficiency. It’s a condition that causes the valves in leg veins to not function properly and impairs the return circulation of blood to the heart.
“It’s not because they had COVID,” Dr. Bajakian says. “It’s because of the significant lifestyle changes that people across the nation have had.”
As Dr. Bajakian explains, “leg veins are working against gravity” to bring blood from our feet back up to our heart. Calf muscles pump the blood through one-way valves that are supposed to keep blood from leaking back down. When those valves stop working properly, patients can develop symptoms like varicose veins, leg ulcers, itching, skin discoloration, and pain.
When people don’t use their calf muscles enough—say, because a global pandemic has forced them to stay home and drastically alter their activity levels—their vein health can suffer.
A “lifestyle” issue
Though not life-threatening, chronic venous insufficiency can be uncomfortable. “I call it a lifestyle issue,” says Dr. Bajakian. “Sometimes patients are not symptomatic and sometimes we're able to compensate for deficiencies in our venous system just by how we live our lives.”
“Sitting at a desk without a lot of movement, and sitting and standing without moving, is what makes people symptomatic,” she says. Dr. Bajakian is seeing patients who used to walk to work, or walk around the office, become sedentary working at home, sometimes spending longer hours than ever at the computer because it’s so easy to be online all day.
The pandemic also limited access to exercise opportunities. People with desk jobs often have gym memberships to make up for the lack of activity during the work day, but gyms and group fitness classes were closed for safety through much of 2020. As a result, “people who were very well compensated for the majority of their lives all of a sudden, without any changes in their actual veins, became symptomatic,” says Dr. Bajakian.
And of course, all that sitting still without exercise led to weight gain, which can further exacerbate vein issues. Inactive adults gained an average of 15 to 20 pounds over the past three years.
As the world has opened up a bit, the return to work—and to being on their feet all day—has also impacted vein health for some people. Dr. Bajakian recalls a patient who was very active running a hospitality company before the pandemic, but had to shut it down for nearly two years. When things started opening up again, he got back to working nonstop, being on his feet all day, and he developed rapid progression of disease.
Although this patient was able to see Dr. Bajakian for treatment, the pandemic made it more difficult for some people to seek medical care, whether because they were uncomfortable having in-person appointments during waves of infection or because an overburdened medical system meant long delays for nonessential treatments.
“There are definitely people who have gone without care for a couple of years,” says Dr. Bajakian. “They have a couple of little varicose veins that they thought maybe needed treatment, but by the time they’ve had to wait a year, they have massively enlarged veins and need a lot more treatment than they did previously.”
The good news is, “vein disease is not a life-threatening disease where if we don’t have preventative medicine there are devastating consequences,” says Dr. Bajakian. Still, the longer it’s left untreated, the more intervention is needed.
Home treatments for venous insufficiency
Dr. Bajakian offers a few key lifestyle modifications to improve venous insufficiency at home.
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Elevate your legs
To compensate for leaky valves in veins, you can elevate your legs above your heart to overcome gravity and help the veins drain on their own. “That's not practical all day long, obviously,” says Dr. Bajakian, “but at the end of the day, if you're reading the newspaper or watching TV, elevating your legs is definitely helpful.” In particular, people who stand all day long at work notice a big difference when they put their feet up at the end of the day.
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Exercise
You don’t need fancy moves or extra equipment: simply take a walk. Dr. Bajakian recommends taking a break to walk around every hour and a half to two hours during the day, and fitting in a longer walk or run before or after work. Walking “gets your calf muscles pumping…and flushes out the system” of extra blood that collects while you’re sitting or standing in one place all day.
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Wear compression stockings
Compression stockings are knee-high socks that use “graded compression,” meaning they’re tight around the foot and ankle and get looser as they go higher up, to help your body circulate blood and decrease swelling. And despite what you may be thinking, they don’t have to be unfashionable! Sporting companies have started making compression stockings that are “almost as good as the prescription-strength” ones, and tend to be a lot more aesthetically pleasing. Dr. Bajakian has several pairs, including some in a pink camo pattern that brings fun, color, and physical relief to long days in the operating room.
What medical intervention looks like
Home treatments can go a long way to reducing symptoms of venous insufficiency, but medical interventions can do more. “They provide so much symptom relief,” says Dr. Bajakian. “While I recommend all of these non-invasive therapies, I do think that it's worthwhile pursuing intervention at a young age if you're symptomatic because there's no great reason to delay it.”
Intervention for venous insufficiency can include catheter-based or ultrasound-guided procedures to seal veins closed, treating several segments of vein and then treating varicosities on surface, “or even treating cosmetic spider veins” once symptomatic issues have been addressed. All of these procedures are safe, effective, and minimally invasive.
“You don't need to take time off from work, from exercise, from any of your daily activities,” says Dr. Bajakian. “There's no downtime for these procedures so it's very easy to fit them into your schedule.”
For more on the latest treatments for vein issues of all kinds, read our article State of the Union: Vein Care in 2022.