Chronic Venous Insufficiency


Chronic venous insufficiency (CVI)  refers to a a syndrome of swelling and pain as a result of poor vein function. There are one way valves in veins that try and prevent blood flow from coming back down the legs. Normally, vein blood travels up towards the heart, while artery blood flows down to the legs. The vein circulation is a low pressure system. There are one way valves inside the veins that try to prevent the backflow of blood into the legs in the wrong direction. If those valves are not working well, blood tends to pool in the leg veins, leading to the diagnosis of CVI (also known as chronic venous disease, or CVD).

WHAT CAUSES CVI?

There are several reasons people present with chronic venous insufficiency. These include the following:
1. Family history of CVI.
2. Excessive body weight.
3. Pregnancy.
4. Lack of exercise.
5. Occupations where one is standing or sitting for long periods of time.
6. Increasing age.
7. Women tend to get CVI more than men.
8. A history of deep venous thrombosis (DVT).

WHAT ARE THE SIGNS AND SYMPTOMS OF CVI?

The typical symptoms of CVI are ankles or calf swelling and tightness. Patients often complain of a heaviness and aching in their legs, typically in the calf area. Typically, the pain associated with CVI is at rest, althought this rule does not always hold true.

The signs of CVI include swelling at the ankles and calf area. There might be varicose veins present. These veins typically look blue, bulging, and twisted. There can be skin changes with rashes, redness, skin color changers and ulcers that might be difficult to heal.

HOW IS THE DIAGNOSIS OF CHRONIC VENOUS INSUFFICIENCY MADE?

The diagnosis of CVI is made through a careful history and physical examination. A duplex ultrasound will usually confirm the diagnosis by visualizing the incompetent vein valves. It is quite rare to need a more invasive study such as a venogram (X-ray dye test of the veins) in order to confirm the diagnosis.

WHAT ARE THE TREATMENT OPTIONS?

The mainstay of treatment for CVI is to wear compression stockings. Compression stockings are elastic stockings that squeeze your legs and prevent the backflow of blood due to the faulty valves. The other components of treatment include excerising regularly in order to help push the blood back towards the heart. The calf muscles act as pumps during contraction, helping to push blood back up the vein system. Weight control is essential in reducing the vein pressure. The more one weighs above the ideal body weight, the more the vein pressure. Elevation of the legs also helps to drain vein blood out of the legs and back towards the heart, reducing vein pressure.

Superficial vein problems due to incompetence of the greater or lesser saphenous veins or their branches can be treated conservatively, or with a more aggressive approach. These aggressive approaches include sclerotherapy, vein stripping or endovenous treatment of the veins.

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