Chronic venous insufficiency (CVI) is a condition in which blood pools in the veins of the leg. This leads to swelling, skin changes and in severe cases, open sores known as ulcers. Several options are available for treating or relieving the symptoms of CVI.
Symptoms of chronic venous insufficiency
Symptoms of CVI that you may experience in your legs include:
- Pain, heaviness, dull aches or cramping
- Swelling of the lower legs or feet
- Varicose veins—swollen, twisted veins visible just under the surface of the skin
- Red, crusted or weeping skin
- Hardening and thickening of the skin on the ankles and legs (lipodermatosclerosis)
- Slow-healing open wounds (ulcers) on the legs or ankles
Symptoms may get worse while standing for a long time and improve after elevating the legs for several minutes. Elevating your legs reduces the pressure in your veins and helps your blood flow back toward your heart.
Treatments for chronic venous insufficiency
Even before treatment, you can take several steps to reduce the severity of your symptoms and help keep your condition from worsening, such as:
- Avoid sitting or standing for longer periods
- Exercise reguarly
- Move more frequently throughout the day
- Take care of open sores or infections on your legs right away
- Lose weight and maintain a healthy weight
- Quit smoking
Your doctor may also suggest that you wear compression stockings. These gently squeeze the legs to help move the blood toward the heart. This can reduce the swelling in the legs and may decrease your chance of developing blood clots.
Other treatments target veins with weak or damaged valves or walls.
The best procedure for your condition depends upon the location of the affected veins and how severe your symptoms are. If a vein is closed off or removed, blood will naturally flow through other healthy veins in the leg. Treatments include:
- Sclerotherapy. A chemical is injected into the vein, which causes the vein to collapse. Over time, it will fade away.
- Endovenous radiofrequency or laser ablation. A small tube (catheter) is inserted into the vein. Radio waves or laser energy is used to heat and close off the vein. The vein will gradually disappear.
- Ambulatory phlebectomy. A vein is removed with a small hook through several small cuts in the skin.
- Vein ligation and stripping. The vein is tied off and then surgically removed. This treatment is now less common and usually replaced by endovenous ablation.
- Valve repair. A valve in the vein can be repaired using stitches (sutures) so it keeps blood from flowing backwards in the vein. A good valve can also be transplanted to a vein with weak or damaged valves.
- Vein transplant. A healthy vein taken from another part of the body is used to create a detour around the damaged vein.
- Angioplasty and stents. A catheter with a balloon on the end is inserted into a partially blocked or weak vein. When the balloon is inflated, it unblocks the vein. A stent may also be placed inside at the same time. This is a small mesh tube which reinforces the vein and keeps it open.
Causes of chronic venous insufficiency
Veins carry blood toward the heart. The veins have valves that keep blood from flowing backwards. When the valves or walls of a vein in the leg are weak or damaged, the blood flow reverses. This allows blood to pool in the veins. It also increases the blood pressure in the veins and can lead to swelling in the legs or feet, along with other symptoms.
CVI may be caused by inflammation of a vein (phlebitis) or a blood clot (thrombosis) in one of the deep veins of the leg. Some people are born without valves in the veins of their legs, which can also lead to CVI.
Several factors increase the risk of CVI, including:
- Family history of CVI or deep vein thrombosis (blood clot) in the legs
- Pregnancy (related to the female hormone progesterone)
- Lack of exercise or physical activity
- Sitting or standing for long periods
- Smoking (in men)
How your doctor diagnoses CVI
Early diagnosis and treatment of CVI can reduce your risk of developing more serious problems later on. Although CVI may not always cause severe problems, this condition can worsen over time and lead to more serious conditions if left untreated. This is especially true for leg ulcers, which are difficult to treat and significantly affect quality of life. They can lead to dangerous infections.
To diagnose CVI, your doctor will do a physical exam and ask about your symptoms and medical history.
An imaging test may be used to see how well the blood flows through the veins in the leg. These can also help identify other problems that may be causing your symptoms, such as a blood clot in a vein in the leg.
The most common imaging tests used are:
- Duplex ultrasound. This procedure uses ultrasound to examine the flow of blood and the structure of the veins in the leg. It is called duplex because two modes of ultrasound are used.
- Magnetic resonance venography (MRV). In this procedure, a large magnet, radio frequencies and a computer are used to make detailed images of the veins in the legs. A special dye is injected into your blood so the blood vessels show up more clearly on the images.