What is Chronic Venous Insufficiency?
Chronic venous insufficiency, or CVI, happens when the leg veins’ valves cannot do their job correctly. Instead of helping pump the blood back to the heart, the weakened valves let the blood accumulate in pockets. These pools of blood, or stasis, can cause pain and swelling. You may also see leg discoloration, ulcers, and bulging veins.
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History of Chronic Venous Insufficiency
Chronic venous insufficiency is nothing new. Because our veins are often visible beneath our skin, they have been the topic of study for thousands of years.
Research surrounding leg veins dates back to 1550 BCE. The earliest writings and sculptures focus on varicose veins’ abnormalities, which often accompany chronic venous insufficiency.
In the 1960s, proper treatment for vascular issues started to emerge. As the technology continued to develop, ultrasounds, lasers, and foam sclerotherapy became the preferred methods to treat venous diseases.
Population and Demographics
Almost half of the United States population has some degree of CVI, but it more commonly affects people over 50. Since pregnancy affects the blood flow to the legs, chronic venous insufficiency is more frequent in the female population.
Causes of the Disease
There is no direct cause of chronic venous insufficiency, but numerous factors can increase CVI probability. Chronic venous insufficiency has multiple causes including hereditary factors/family history, aging process, pregnancy/multiple pregnancies, jobs requiring long periods of sitting or standing, obesity, injury/damage to the veins, prior history of DVT, and being tall in stature
Signs and Symptoms
While many people may think that chronic venous insufficiency comes with varicose veins, that is not always true. Some patients do experience enlarged varicose veins, but it is not a consistent sign of CVI. Chronic venous insufficiency and fatigue are a more common pairing.
Instead, watch for swelling in your calves and ankles, flaky and itchy skin, leg cramps, and cramping. You can also experience restless leg syndrome, burning, heaviness, and tiredness. Watch the skin for signs of stasis ulcers and any changes to the appearance, especially if it begins to look like leather.
The severity of symptoms varies greatly depending on the progression of the disease. If you have just a couple of the above signs, talk to your doctor. Your veins will not strengthen on their own, and they will continue to weaken with time and age.
With early intervention, you can avoid burst capillaries that change your skin color and problematic ulcers.
- Visible varicose veins
- Leg swelling
- Achiness of the legs
- Heaviness of the legs
- Fatigue in the legs
- Restless legs
- Discoloration of the skin in the lower legs/ankles
- Open sore/ulcers in the lower legs/ankles
Being pregnant at least once can also contribute to CVI, as the added weight of the baby and the bodily changes directly affects the blood flow throughout the legs.
Failure to exercise and standing or sitting for extended periods can also provoke CVI since it creates more pressure.
The most common cause of chronic venous insufficiency is a current or past blood clot (called deep vein thrombosis, DVT). A lump in the deep veins can cause significant harm to the leg veins. Even if you are unaware of the damage, you may see symptoms of CVI develop.
Chronic Venous Insufficiency Diagnosis
Diagnosis of chronic venous insufficiency is done by obtaining a detailed history and physical including the patient’s primary medical history, presenting symptoms, and risk factors.
Venous duplex studies or Ultrasound may be done to detect any abnormal blood flow patterns in the veins in the legs. This is done by placing a probe over the skin that allows the technologist to visualize the blood flow in the veins. This testing typically requires the patient to stand through a portion of the testing and you may be asked to perform certain breathing techniques as well.
The venous insufficiency ultrasound is the most common imaging method used in diagnosis. This simple test gives the doctor a visual representation of how the veins in your leg are working. The images will show if the blood is moving the correct way or if you have deep vein thrombosis.
Other possible tests include various types of venograms, in which they insert a contrast into your veins to get quality images of potential blockages.
Treatment
Depending on how severe your CVI is, your doctor may recommend any number of treatment plans. If you are still in the early stages, the main goal is to prevent painful swelling and ulcers. To do so, you can eat a healthy diet, exercise more, wear compression socks, and routinely change positions to improve blood flow. Another option may be certain types of medicine that lower your chance of blood clots.
Conservative management measures to help treat symptoms of the disease include use of compression stockings, leg elevation, routine exercise, and maintaining a BMI <30. Conservative management measures will help to manage symptoms and slow progression of the disease however this will not cure or reverse superficial venous reflux.
If you have serious venous insufficiency, you may need to undergo specific treatment such as sclerotherapy. This process involves your doctor injecting a substance into the particular vein that is causing trouble. The vein then closes, and the blood takes another healthier route.
Minimally invasive procedures
Recent treatment of superficial venous reflux is typically done in the outpatient setting with minimally invasive techniques which may include ablation or closure of the veins that do not function properly. By doing this blood flow is diverted into the deep veins and reduces the pressure and/or pooling of blood in the superficial veins. The procedure(s) typically take approximately 1-2 hours and allow for you to return to your normal activity level with minimal restrictions on the same day. There is minimal risk involved with these procedures and decreases, bruising, minimal scarring, using small incision.
Radiofrequency(RF) or laser ablation - This is a procedure done by introducing a special catheter inside the superficial vein to be treated much like starting an IV. Once the catheter is in place energy is transferred through the tip of the catheter to seal the vein shut.
Foam Sclerotherapy - This is a procedure done by injecting a special type of medication into the vein that causes a inflammatory response inside the vein causing it to seal closed.
Microstab phlebectomy - Varicose veins may be treated by performing microstab phlebectomy to remove small pieces of the bulging vein. This is done by making a small puncture or incision at the site of the vein and removing small segments to interrupt the blood flow through the vein which causes the vein to collapse and become less prominent.
If deep vein disease processes are identified such as post-thrombotic syndrome or iliac vein compression, additional evaluation and treatment may include venography, Intravascular Ultrasound (IVUS), venoplasty and stent placement. These are all minimally invasive procedures typically done in the outpatient setting.
Chronic Venous Insufficiency Prevention
If you are at a high risk of getting chronic venous insufficiency (obese, smoker, over 50 years old), take some of the following precautions to avoid CVI.
- Stop smoking
- Lose any extra weight
- Eat healthily and get routine exercise
- Try not to sit or stand for extended periods
- Adjust your workspace to alleviate any pressure on your legs
- Invest in shoes with extra support
None of these things will guarantee that you won’t get CVI, but they all contribute to a healthy lifestyle with low blood pressure, which reduces your risk of venous insufficiency.
Disease Progression
The first signs of CVI include spider and varicose veins. From there, the disease causes excessive swelling in the calf and ankle area, often provoking discoloration near the feet.
If left untreated, the skin may begin to change to look and feel like leather. The final stage is the formation of open ulcers on your skin that are hard to treat.
It is best to talk to a doctor as soon as you see any spider or varicose veins to start handling the pressure before it becomes worse.
This article is a comprehensive overview of Chronic Venous Insufficiency. However, it should not take the place of speaking with a physician. If you are experiencing any of the symptoms listed above, or know someone who is, contact us today to schedule a consultation.
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