Chronic Venous Insufficiency: Symptoms and Treatment

Blood returns to the heart from the body via the veins. Veins are equipped with valves to ensure unidirectional flow of blood. Incompetency of these valves causes blood to pool in the veins instead of returning to the heart; this condition is called chronic venous insufficiency (CVI). About 40% of Americans are affected by chronic venous insufficiency. CVI is generally seen in the veins of the lower limb.

Causes of CVI

CVI does not have one particular cause. There are multiple factors that may lead to the disease. Risk factors that may predispose a person to CVI are:

• Obesity: obese individuals are more likely to suffer from CVI
• Smoking: increases the risk of CVI
• Deep vein thrombosis (DVT): formation of a blood clot in the deep vein may damage the valve leading to incompetency
• Women with multiple pregnancies are a greater risk
• High blood pressure in the veins due to prolonged sitting or standing
• Injury to the leg leading to inflammation of the veins
• Lack of exercise.

There are rare congenital diseases which lead to a complete absence of valves in the vein. Individuals with these diseases are likely to experience CVI.

Symptoms of CVI

Your doctor might suspect that you have CVI if you are experiencing:

• Swelling in the leg after periods of prolonged standing or sitting
• Pain in the leg
• Darkening of skin colour around your ankles or lower leg
• Itching in lower leg
• Varicose vein
• Cramps.

Diagnosis of CVI

To reach to a diagnosis of CVI your doctor would like to record a detailed history of your symptoms; followed by a thorough physical examination. To confirm the diagnosis a duplex ultrasound may be requested. A duplex ultrasound is performed by a healthcare provider to visualise and assess the flow of blood in your veins. A small transducer will be placed on your leg; the transducer emits ultrasound and converts the signals from your leg into an image on the screen which will be analysed by the provider.

Complication of CVI

According to a Queens vein doctor, CVI is a common disease which is identified in its early stage, can be treated easily. If left untreated for long it may lead to ulcers in the leg. These ulcers are extremely difficult to heal and have a tendency to get infected and may lead to a dreaded complication, cellulitis.

Treatment of CVI

Treatment of CVI classified into three modalities; lifestyle changes and medical therapy, non surgical treatment, surgical treatment.

• Lifestyle changes and medical therapy: generally reserved for early stages of CVI.
• Compression stockings: wearing properly fitting support hose ensures that the blood doesn’t pool in the leg and hence reduces the risk of complications of CVI. Wearing compression stockings doesn’t cure CVI, it only treats the symptoms.
• Regular exercise
• Quitting smoking
• Avoid standing or sitting for prolonged interval
• Antibiotics: for skin infection
• Anticoagulants may be prescribed if you have a history of deep vein thrombosis.
• Non surgical therapy
• Sclerotherapy: under the effect of anaesthesia your provider will inject a solution into the affected veins, causing them to collapse. This therapy reduces the risk of complications.
• Endovenous thermal ablation: after numbing your leg with an anaesthetic agent, your provider will insert a specialised catheter into the affected vein. The tip of the catheter is designed to produce intense heat, which causes the vein to collapse.
• Surgical therapy: this mode of therapy is required by less than 10% of the patients.
• Ligation and stripping: your surgeon ligates the affected vein, hence preventing pool of blood. This procedure is generally accompanied by stripping; wherein the affected vein is removed from the body. Recovery from these procedures is longer than the non surgical procedure.
• Vein bypass: a healthy vein from your body is used to reroute the blood away from the affected vein. This procedure is done in the upper thigh and reserved for individuals who haven’t responded to other forms of therapy

reSources

• Society for vascular surgeon: chronic venous insufficiency
• Minimally invasive techniques in the treatment of saphenous varicose veins.
• J Am Acad Dermatol.  2009; 60(1):110-9 (ISSN: 1097-6787)