All About Chronic Venous Insufficiency (CVI)

Chronic venous insufficiency (CVI), also known as chronic venous disease (CVD), is a condition in which problems with vein circulation impede the return of blood from the legs to the heart. Doctors do not always agree on the definition of CVI, but the symptoms of CVI are clear: leg swelling, skin darkening and sometimes scarring.

People who have CVI sometimes develop varicose veins, which are swollen, thickened veins visible on the surface of the skin. In more severe CVI cases, sores and ulcers can develop. CVI is a chronic circulatory condition which is not considered serious, but it can cause pain, discomfort and physical changes in the legs. Your doctor can help manage CVI with a variety of treatments.

Treating CVI

CVI is a chronic condition which needs to be continually monitored and managed. Depending on the severity of your symptoms, treatment options can range from wearing supportive stockings, to more invasive treatments which aim to clear venous passages or repair venous structure through surgical or non-surgical techniques.

A healthy lifestyle can go a long way in managing CVI. Your doctor will encourage you to exercise regularly to get your blood flowing. If your job involves much sitting, you will be encouraged to periodically get up and move! Walking is great exercise for people who suffer from CVI. If you stand for prolonged periods of time during the day, you will be encouraged to rest periodically and stay off your feet.

Compression therapy is essential in managing CVI. Compression treatment can be administered in the form of compression bandages or compression stockings. Compression stockings, otherwise known as support hose, can be purchased as pantyhose, or as above the knee or below the knee sock varieties. Compression stockings provide low levels of compression (8-10 mm Hg) and can be purchased at your local pharmacy or at specialty medical retailers. Compression stockings which provide higher levels of compression (40-50 mm Hg) may require a doctor’s prescription.

Medication such as antibiotics may be prescribed to clear up skin infections caused by CVI. Topical ointments and creams can help protect your skin and keep you comfortable. Creams containing hydrocortisone alleviate itchiness. Ointments containing zinc-oxide help protect your skin. Anti-fungal creams help treat fungal infections.

The herbal supplement Vena-Stat, containing horse chestnut oil, has been found in some cases to be helpful in treating varicose veins. Check with your doctor about potential drug interactions before you begin vena-stat or any other supplement or medication.

Medical Procedures for CVI

CVI can be treated using non-surgical procedures which bypass or eliminate injured or collapsed veins. Sclerotherapy is a procedure where your doctor injects a chemical into vein, causing it to scar and be absorbed into the body. Ablation (endovenous thermal ablation) uses heat to destroy the vein. Laser therapy uses focused laser beams to destroy a problem vein.

Surgical procedures to treat CVI are only recommended in advanced cases where pain and symptoms are severe. Ligation is a surgical procedure where a vein is tied off completely. If the vein is severely damaged, it may be stripped by making two small incisions in the leg to cut and remove the vein. Ambulatory phlebectomy is a procedure which uses small incisions or needle punctures to sever a vein and a special medical hook (phlebectomy hook) to remove the vein.

Valve repair is a procedure where individual valves are repaired through an incision in the leg.

When leg wounds are not healing due to improper circulation, or in cases of severe blockage, blood can be re-routed past a blocked vein. Vein bypass surgery uses a blood vessel from a different part of the body to create a detour around a problem vein. Angioplasty is a procedure where a small balloon is placed into a blocked vein and inflated to improve blood flow. A small mesh tube called a stent can be used to hold a vein open and prevent future blockage.

Though CVI is rarely serious, it tends to get worse over time. Much can be done to slow the condition and alleviate uncomfortable symptoms. Make an appointment with your doctor if you are concerned about CVI.

What are the symptoms of CVI?

When blood chronically pools in the veins, symptoms manifest as:

  • Swelling in legs or ankles
  • Tiredness or itchiness in legs and feet
  • Skin texture becomes feathery or flaky
  • Varicose veins (swollen, twisted veins visible on the surface of the skin)
  • Hyperpigmentation (darkening of the skin) around the legs and ankles
  • Lipodermatosclerosis (thickening of the skin) around legs and ankles
  • Superficial wounds and cuts take a long time to heal.
  • Venous stasis ulcers (sores as a result of ‘static” blood)

Folks with CVI may find that their symptoms of tiredness and swelling are made worse by standing for long periods of time, and alleviated by resting and putting their feet up.

How your doctor diagnoses CVI

To diagnose CVI, your doctor will take a thorough medical history and a physical examination of your legs, ankles and feet to check for physical signs or swelling. Bring any symptoms of CVI or any other concerns to your doctor’s attention during your appointment. Your doctor may prescribe a number of tests to check venous blood flow and the structure of your veins.

A duplex ultrasound is used to test the blood flow through your veins. Both Doppler ultrasound and B-mode ultrasound are used during a duplex ultrasound (hence the term duplex.) A Doppler ultrasound tests the speed and direction of blood flow through the veins, and a B-mode ultrasound transmits an image of the vein to your doctor.

A venogram is a test whereby a contrast dye is injected into your veins and then x-rayed to produce images of your veins. Venogram images give your doctor a picture of your blood flow and helps detect problems with your valves.

What causes CVI?

CVI can refer to a variety of problems with venous circulation. Veins carry blood towards the heart. In the legs, blood is carried against gravity upward towards the heart. One-way flaps called valves prevent blood from flowing backwards. There are several reasons why CVI may occur. When vein walls are weak or valves are damaged as a result of injury, age, or disease, blood circulation is compromised, and venous stasis may occur, where blood remains static (standing still) and pool in the veins. Weak or abnormal valves may also allow venous reflux, where blood can backtrack down the legs. Venous obstruction (obstructions in the veins) is another reason why blood circulation in the legs can be compromised. These factors all contribute to the physical symptoms of CVI.

Are you prone to CVI?

You may be at a higher risk for developing CVI if you:

  • Spend long times sitting or standing
  • Are obese
  • Have experienced pregnancy or multiple pregnancies
  • Smoke
  • Are female
  • Are over the age of 50

You can reduce your risk factors by making some healthy lifestyle changes, such as quitting smoking, adding more activity in your day and losing weight.

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