What is Chronic Venous Insufficiency?
Chronic Venous Insufficiency (CVI) is a condition that occurs when
the venous wall and/or valves in the leg veins are not working properly.
This makes it difficult for blood to return to the heart from the legs.
CVI is characterized by lower leg/ankle swelling, eczema, discoloration, hardening of the skin, scarring and/or venous ulceration.
Symptoms such as achy, painful, heavy or tired legs are common.
What causes it?
Arteries bring oxygen-rich blood from your heart to your body and veins return the blood back to your heart and lungs to get re-oxygenated. The blood in the veins is pumped by contraction of the muscles of your legs and feet. There are one-way valves in the veins that allow blood to flow up only, back toward the heart, and prevent the blood from flowing back down the vein. If the valves are not working properly backward flow called reflux occurs.
Reflux and/or blockage in veins can lead to a build up of pressure in the vein system. This will cause spider and/or varicose veins to develop. While these can be of cosmetic concern, symptoms such as leg heaviness, fatigue, aching, restlessness, cramps, itching and other symptoms can occur. If the condition is severe enough it can cause chronic venous insufficiency, with lower leg swelling, eczema, discoloration, hardening of the skin, scarring and/or venous ulceration.
The most common cause of valve dysfunction is varicose veins, usually inherited from a family member. Blood clots (DVT) can also damage valves and/or cause blockage of flow in the vein. Although CVI can affect anyone, it is more common as we age.
What tests will I need?
Initially your physician will take a history regarding your general health, past medical history, and current symptoms. A physical exam is then done. Typically the next step is to have a duplex ultrasound of your leg(s), which enables examination of the veins that are below the skin. An ultrasound is necessary to determine the full picture of the cause of your vein problems, and is critical to developing a proper treatment plan.
How is it treated?
Treatment will depend on a variety of factors, including what the underlying cause for your vein problem is. A proper treatment plan depends on a well-done history and physical, and duplex ultrasound exam.
Compression stockings compress your veins and decrease backward flow. This can reduce swelling, provide relief from symptoms, and even help heal venous leg ulcers.
You can help decrease leg swelling and other symptoms by elevating your legs and avoiding prolonged standing or sitting still. Walking and other aerobic activity can help promote good blood flow in the veins. You can reduce symptoms of CVI by maintaining your ideal body weight or losing weight if you are overweight.
Ambulatory Phlebectomy may be used to treat large, bulging varicose veins.
Endovenous Ablation is used to treat problem veins that are below the skin.
Sclerotherapy is used to treat dysfunctional visible varicose veins.
Ultrasound-guided sclerotherapy is used to treat underlying dysfunctional veins.
Surgical procedures are rarely needed.