Chronic venous insufficiency (CVI) is a vascular condition in which the veins in the lower extremities have difficulty sending blood from the legs back through the heart. The result can evolve into a myriad of potential medical issues and physical symptoms.
The anatomy of veins
Every person’s body is a map of veins and arteries. Our arteries carry oxygen-rich blood from the heart through the rest of the body. Our veins then carry oxygen-depleted blood back to the heart to be replenished with oxygen. The venous system needs to have effectively functioning valves or one-way flaps to ensure that this exchange happens effectively.
If the valves within the veins are not functioning properly, blood that should be returned to the heart, instead flows in reverse or back into the legs. This back flow of blood creates weakened walls of the veins and potential valve damage. The ensuing result is chronic venous insufficiency (CVI). CVI can manifest as spider or varicose veins, among other issues.
The main focus of treatment for chronic vascular insufficiency is to reduce the discomfort and accompanying disability. The first lines of defense are aimed at prevention and relatively simple:
- Gradient compression stockings will help decrease leg swelling
- Avoid standing for long periods of time
- Move legs as much as possible to increase circulation
Sclerotherapy injections are usually the first invasive intervention to treat the symptoms of CVI.
It is important to note that less than 10 percent of those affected by CVI require any surgical intervention. More invasive surgical treatments include:
- Varicose vein stripping surgery
- Bypass graft surgery
- Valve repair in affected veins
- Angioplasty and stenting of veins behind the knee or in the groin
The Prognosis: Chronic venous insufficiency is a long-term condition. Left untreated, chronic venous insufficiency is a progressive disease. It is estimated that 2-5 percent of Americans have some element of CVI.
The possible underlying causes of CVI for each patient need to be evaluated and promptly treated by a healthcare professional in order to prevent disease progression and further complications. Left untreated, chronic venous insufficiency can lead to increasing complications.
Based upon physical examination and a medical history, there are some common tests to confirm a diagnosis of chronic venous insufficiency.
The diagnostic process is often initiated with an ultrasound. This painless procedure uses sound waves to measure blood flow and vein structure in the legs.
A venogram is a more invasive study during which dye or contrast is injected into the leg veins to evaluate the blood flow.
The symptoms of CVI
Every patient presents with their own set of symptoms but the following are the most common complaints associated with CVI:
- Swollen ankles
- Tightness in calves
- Leg cramps
- Pain when walking
- Varicose veins
- Leg ulcers
Risk ractors for CVI
There are many physical factors that can affect a person’s risk of developing CVI. High blood pressure, congenital defects in the veins, a history of deep vein thrombosis (DVT) and phlebitis are among the leading causes of chronic venous insufficiency. Women over 50 years old are at the greatest risk of developing CVI.
Some lifestyle factors that affect the risk of developing CVI include:
- Family history of varicose veins
- Lack of exercise
- Standing or sitting for extended periods of time