Chronic Venous Insufficiency
What is Chronic Venous Insufficiency?
Under normal circumstances, the veins in the legs rely on one-way valves and muscle contractions to propel blood upwards and prevent backflow. With CVI, these valves become damaged or dysfunctional, often due to age, blood clots, inflammation, or injury.
Faulty valves allow some oxygen-depleted blood to flow backward and pool in the veins, especially when standing or sitting. This venous reflux increases overall venous blood pressure and further taxes the damaged valves.
Over time, the vein walls and valves weaken and the veins become swollen, enlarged, and tortuous – a condition known as varicose veins. Varicose veins have a greater tendency to twist, which can worsen blood flow. All of these factors promote the progression of chronic venous insufficiency.
Causes & Symptoms of Chronic Venous Insufficiency
The underlying cause of chronic venous insufficiency (CVI) is damage to the valves in the veins of the legs. These valves help to keep blood flowing in the correct direction, from the legs back to the heart. When the valves are damaged, blood can pool in the legs, leading to CVI.
Causes of Chronic Venous Insufficiency
The risk of CVI increases with age. The valves in the veins of the legs become weaker and less elastic over time, making them more likely to be damaged.
People with a family history of CVI are more likely to develop the condition. This is because they may have inherited genes that make them more susceptible to damage of the valves in the veins of the legs.
During pregnancy, hormonal changes and increased pressure on the veins of the legs can damage the valves. The weight of the baby and the uterus can put extra pressure on the veins in the legs, making it harder for blood to flow back to the heart.
Excess weight puts extra pressure on the veins of the legs, which can damage the valves.
- Prolonged standing or sitting
When you stand or sit for long periods of time, the blood in your legs has a harder time flowing back to your heart. This can damage the valves in the veins of your legs.
- Deep vein thrombosis (DVT)
A blood clot in a deep vein in the leg can damage the valves in the vein. A blood clot can form in a deep vein of the leg when blood flow is slowed down. This can happen if you sit or are immobilized for long periods of time, or if you have a condition that makes your blood more likely to clot.
Symptoms of Chronic Venous Insufficiency
- Leg swelling
This is the most common symptom of CVI. The swelling is usually worse in the ankles and feet, and it may be worse after standing for long periods of time.
- Leg pain
The pain is often described as a dull ache or heaviness in the legs. It may be worse after standing for long periods of time or after exercise.
- Varicose veins
Varicose veins are enlarged, twisted veins that are visible just under the skin. They are a common symptom of CVI, but not everyone with CVI has varicose veins.
- Skin changes
The skin around the ankles and feet may become discolored, itchy, or flaky. In some cases, skin ulcers may develop.
- Restless legs syndrome
This is a condition that causes an irresistible urge to move your legs. It is often worse at night.
- Leg cramps
Painful muscle cramps, particularly during the night.
Testing & Diagnosis for Chronic Venous Insufficiency
Diagnosing Chronic Venous Insufficiency (CVI) involves a combination of clinical evaluation, medical history assessment, and specialized tests. A thorough diagnosis is essential to determine the extent of the condition and its underlying causes, and to tailor an effective treatment plan. Vascular specialists use various methods to accurately diagnose CVI and identify the best course of action for each individual.
- Physical Examination
A vascular specialist will perform a comprehensive physical examination, focusing on the legs. They will assess the presence of varicose veins, skin changes, ulcers, and any signs of venous insufficiency.
- Medical History
Gathering information about your medical history, including family history of vein problems, lifestyle factors, and past vein-related conditions, helps provide valuable insights into your risk factors and potential causes of CVI.
- Doppler Ultrasound
This non-invasive imaging technique uses sound waves to create detailed images of blood flow in the veins. Doppler ultrasound can identify blood flow abnormalities, valve dysfunction, and the extent of venous insufficiency.
- Venous Reflux Study
This specialized ultrasound assesses the direction and speed of blood flow in the veins. It helps identify any backward flow of blood (reflux) caused by valve dysfunction.
In some cases, a venogram may be recommended. This involves injecting a contrast dye into a vein and taking X-ray images to visualize blood flow and any blockages.
- Duplex Ultrasound
Combining traditional ultrasound with Doppler ultrasound, this test provides detailed images of blood flow and structure, assisting in evaluating the severity of CVI and guiding treatment decisions.
- Other Imaging
Magnetic resonance venography (MRV) or computed tomography venography (CTV) might be used to assess deep veins in complex cases.
Chronic Venous Insufficiency Treatments
While there is no cure for chronic venous insufficiency (CVI), various treatments can effectively manage symptoms and improve leg health. Treatment focuses on improving blood flow back to the heart, reducing venous pressure, alleviating discomfort, and preventing complications.
Your vascular specialist will determine the best treatments tailored to your individual case, symptoms, and vein anatomy. The goal is to prevent symptom progression and complications like leg ulcers. Consistently following the treatment plan is key. Some key CVI treatments include:
- Prescription compression stockings
Gradient compression helps move blood up the legs and reduces vein wall distension. Stockings may be worn daily.
- Leg elevation and movement
Elevating legs and flexing foot muscles helps blood circulate back up the legs. Avoid prolonged standing/sitting.
Physical activity improves overall leg muscle function and venous circulation.
Diuretics, vasodilators, or anticoagulants may be prescribed to reduce swelling and improve flow.
- Ablation procedures
Damaged veins can be sealed shut using thermal (laser, radiofrequency) or chemical ablation.
- Vein stripping/ligation
Surgical options to remove or tie off damaged surface veins.
- Skin care
To properly clean and treat any leg ulcers using wound dressings/compression.
- Lifestyle changes
Losing weight, quitting smoking, and staying active helps minimize symptoms.
- Medical-grade compression devices
Pump air pressure around legs/feet to increase circulation.