What is Chronic venous insufficiency (CVI) ?
The function of the veins is to return the blood upwards to the heart. However the gravity acts in exactly opposite direction. The veins have valves to prevent the blood falling back downwards. Chronic venous insufficiency is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, causing the blood to leak downwards consequently making it difficult for blood to return to the heart from the legs and causes blood to “pool” or collect in these veins, and this pooling is called venous stasis.
Chronic venous insufficiency that develops as a result of DVT is also known as post-thrombotic syndrome. As many as 30 percent of people with DVT will develop this problem within 10 years after diagnosis.
CVI is often associated with varicose veins, which are twisted, enlarged veins close to the surface of the skin. They can occur almost anywhere, but most commonly occur in the legs.
What are the symptoms of CVI?
As the disease progresses, the complexities of the disease and its treatment and seriousness increases.
This is precisely the reason why it is very important to see your doctor if you have any of the symptoms of CVI. The problem will not go away if you wait, and the earlier it is diagnosed and treated, the better your chances of preventing serious complications.
Symptoms include:
Swelling in the lower legs and ankles, especially after extended periods of standing
Aching or tiredness in the legs
New varicose veins
Leathery-looking thick skin on the legs
Flaking or itching skin on the legs or feet
Stasis ulcers (or venous stasis ulcers)
If CVI is not treated, the pressure and swelling increase and cause inflammation and result in a condition called lipodermatosclerosis. The pressure can increase until the tiniest blood vessels in the legs (capillaries) burst. When this happens, the overlying skin takes on a reddish-brown color and is very sensitive to being broken if bumped or scratched.
At the least, burst capillaries can cause local tissue inflammation and internal tissue damage. At worst, this leads to ulcers, open sores on the skin surface. These venous stasis ulcers are difficult to heal and can become infected. When the infection is not controlled, it can spread to surrounding tissue, a condition known as cellulitis.
How to diagnose?
To diagnose CVI, your doctor will take a complete medical history and physical exam where doctor will carefully examine your legs. A test called duplex or Doppler ultrasound may be used to examine the blood circulation in your legs. During the vascular ultrasound, a transducer (small hand-held device) is placed on the skin over the vein to be examined. The transducer emits sound waves that bounce off the vein. This modality is radiation free and is completely safe. These sound waves are recorded, and an image of the vessel is created and displayed on a monitor. This study helps evaluate competence of valves and also status of patency of veins.
How is CVI treated?
The most conservative way to treat is to wear compression stockings. They come in different compressions varying from 8 to 10 mm Hg, up to 40 to 50 mm Hg and of varying lengths and sizes. Your doctor can recommend the compression that is right for you.
If you wear compression stockings, be sure to take them off at the end of the day to wash and dry them, and to clean and check your skin. Make sure the stockings fit so there is no bunching. Elastic stockings that fit poorly can actually make your condition worse by blocking blood flow in the area where they have bunched up.
How to Treat and prevent chronic venous insufficiency?
To treat CVI and also to reduce your risk of developing CVI, one must follow these guidelines:
Eat a healthy balanced diet.
Quit smoking, alcohol
Get active and exercise regularly
Avoid wearing tight clothing such as tight girdles or belts.
If you are overweight, you need to lose weight.
Avoid prolonged sitting or standing.