Chronic Venous Insufficiency (CVI) or Leg Swelling

CVI, or leg swelling, is an extremely common disorder that affects millions of Americans. Untreated, venous insufficiency causes high pressure in your veins that worsens over time and can cause significant and painful permanent changes to your skin. This places you at increased risk for skin breakdown or ulcers which are very difficult to heal. This condition is worsened by prolonged standing and sitting, increased salt and fluid consumption and especially by weight gain and obesity. The good news is that patients can obtain significant relief and lead a normal and productive lifestyle if they are compliant with specific lifestyle changes as described below.

In healthy veins, there are multiple one-way valves that only allow blood to flow upward, out of your legs back to your heart. When you stand or sit, the valves close and prevent blood from flowing backwards into your legs. Over time, valves can leak and blood flows downwards, back into your legs. This causes high pressure in your leg veins and causes fluid to leak out and build up in your legs due to the effects of gravity. Pigment from your blood builds up under your skin and causes permanent darkening of your skin. There are good options to improve your condition. These can give you great relief and protect your legs from permanent damage, but this requires a strong commitment on your part. Please read and follow these guidelines carefully.

Compression Stockings: Compression tockings are the mainstay of treatment. TED hose, or Thrombo-Embolic Deterrent Hose, given during routine surgery or stockings purchased at the department store or grocery store are not adequate because they do not provide enough compression. Good compression stockings are difficult to apply and expensive, but they last a long time and are very effective. They may cause an indentation in your skin at the top of the stocking, but this is not harmful, and they will NOT cut off your circulation. You must elevate your feet ABOVE YOUR HEART overnight or apply first thing in the morning before you walk around during day to minimize the swelling before you apply your stockings. You can take your stockings off whenever your feet are elevated.

You should purchase compression stockings from a specialty shop or The Heart House to receive a proper fit and tips on how to best apply them. Durable Medical Equipment (DME) Stores carry these stockings at full retail, where they cost $80-$130 for thigh-high or panty stockings. If custom stockings are required, the price can be much higher. Insurance does not cover these. Note: It is preferred for patients to have either thigh-high or full-panty stockings. This is a post-procedure standard to ensure proper compression of the great saphenous vein or GSV. The stockings offered at the Heart House may be washed and dried as normal and have a year warranty.

Leg Elevation: Your legs must be elevated above the level of your heart to receive the benefits of gravity. To accomplish this, your toes should be higher than your nose. Simply lying on a recliner chair is not adequate. You can place a board under the foot of your bed and sleep with your feet on pillows. During the day, you can lie on the floor and keep your feet on the couch or lie on the couch with your feet on the armrest. Ideally, you should keep your feet elevated as much as possible when you are not walking or wearing compression stockings. If you’re on your feet all day at work, take whatever breaks you can to elevate your feet as high as possible. Ideally, you should either be walking or have your legs elevated as much as possible. Sitting and standing are the worst positions for your swollen legs.

Weight Loss: Even small amounts of weight loss are significant and will greatly improve your symptoms. All the fluid in your legs has to go through your abdomen (belly) to get back to your heart. Quick weight loss diets on TV are a scam and are a waste of your time and money. The bottom line for success: You must combine increased exercise with decreased consumption of calories.

Salt Restriction: Salt causes you to retain fluid in excess of what your body needs. Gravity and bad veins cause this fluid to accumulate in your legs. Patients always say they do not add much salt to their food. However, there is a huge amount of added salt in nearly all processed, pre-packaged, canned, restaurant, fried and fast-foods. Look at the salt content in any diet book and you will be amazed. Try to limit your salt consumption to less than 2 grams per day.

Exercise: An active lifestyle will help with weight loss and is certainly beneficial to your heart and longevity. Walking causes your calf muscles to contract (squeeze) which compresses the fluid out of your veins and pumps it up your legs back towards your heart. Walking with your compression stockings in place helps prevent fluid from building back up after it is pumped out of your legs by walking. You should exercise at least 30 minutes a day, 4 or 5 days a week. Exercise should be of moderate intensity in order to elevate your heart rate significantly. Ideally, you should continue to increase the intensity of your exercise as much as possible (that is, walking or biking further and faster over time). You should check with your cardiologist first if you have any history of heart disease before beginning any exercise program.