What Is Chronic Venous Insufficiency? How Is It Treated?

It is estimated that approximately 40% of people in the United States have some form of chronic venous insufficiency or known as (CVI).

If you are worried you may have venous insufficiency, you are not alone.  Seeking timely treatment from a trained vein specialist can help reduce your symptoms of stop the CVI from further progressing.

What Is Chronic Venous Insufficiency?

Healthy arteries and veins work together to continuously move blood from your heart to the rest of your body. Veins, with the assistance of valves in the veins, will carry blood back to the heart. These unique valves are one-way valves and work to keep blood from flowing backward.

Venous insufficiency develops when the wall or valves of the veins cannot return the blood back to the heart efficiently, causing the blood to pool in the veins of your legs.

What Causes Chronic Venous Insufficiency?

Venous disease is most often caused by Deep Vein Thrombosis (blood clots) and untreated varicose veins. However other factors may also contribute to CVI.

Standing For Long Periods Of time

Professions that require standing for longs periods of time, such as nurses, restaurant staff, or teachers, spend lengthy periods on their feet.  

When you are required to stands for extended periods of time, the blood in your leg  veins may begin to pool and flow backward.  Over time, and without conservative interventions (such as stretching, moving or compression therapy), the pooling causes pressure in the veins, causing them to weaken.

Blood Clots

Blood clots obstruct the forward flow of blood through the veins, allowing blood to pool and collect below the clot.  As blood continues to pool, the increased pressure in the vein (known as venous hypertension) further weakens the veins and valves in the veins.

Varicose Veins

Often, when varicose veins are present in the lower legs and left untreated, the valves in the veins have become damaged or weakened, allowing the blood flow to leak back through the valves (known as backflow or venous reflux).

Additional Risk Factors Include:

It is more common for women to develop chronic venous insufficiency.

Additional risk factors that may cause venous insufficiency:

• Being over the age of 50
• Family history of vein disease
• Obesity
• Pregnancy
• Sitting or standing for prolonged periods (contributes to elevated blood pressure)
• Lack of exercise
• Smoking
• Cancer
• Leg injury or surgery
• Phlebitis (swelling of a superficial vein)
• Deep Vein Thrombosis (DVT)

What Are The Symptoms of Chronic Venous Insufficiency?

You may experience the following symptoms if you have venous insufficiency:

• Varicose veins
• Spider veins 
• Leg Swelling in the ankles and calf muscle
• Discomfort or restlessness in your legs
• Leg tiredness and aching
• Skin discoloration, typically near the ankles
• A feeling of tightness, itchiness or warmth in your calves
• Leg ulcers 
• Venous stasis ulcers
• Heaviness
• Leg Cramping

Chronic venous insufficiency is not serious but may develop into more dangerous conditions if not treated properly.

If left untreated, the ongoing pressure causes capillaries in the legs to burst. When this continues, the skin typically takes on a reddish-brown color and is more sensitive to injury. Also, the surrounding skin tissues can become inflamed, which can lead to internal tissue damage if not treated.

In its most severe state, chronic venous insufficiency leads to open sores, known as venous ulcers on the skin surface. Once open, ulcers can be challenging to heal and are prone to increased risk of infection.

Know The Stages of Venous Insufficiency

There are 3 categories or stages of CVI which depend upon the severity of your symptoms.

• Stage 1:  Swelling and changes in skin pigmentation
• Stage 2:  Swelling, changes in skin pigmentation and dermatitis
• Stage 3:  Swelling, changes in skin pigmentation, dermatitis, varicose veins and venous ulcers

How Is Chronic Venous Insufficiency Diagnosed?

To determine if venous sufficiency is present, your doctor will thoroughly review your medical history and perform a physical examination. 

Imaging tests, such as a venogram or duplex ultrasound, are very helpful in locating the source of the problem.

Venogram

A venogram is an x-ray performed in conjunction with the use of intravenous (IV) contrast dye in your veins. The contrast will cause your veins to appear opaque in the x-ray image and provides a clear picture of your blood vessels

Duplex Ultrasound

A duplex ultrasound looks at the structure of your leg veins and can review the speed and direction of your blood flow.

The procedure is painless and easy. A technician will place gel on your skin and use a hand-held device called a transducer. The transducer, when pressed against the skin, produces sound waves that bounce back to the computer as images.

How is Chronic Venous Insufficiency Treated?

Treatment will depend upon several factors:

• Age
• Severity
• Symptoms
• Medical history and overall health
• How you handle certain medications
• Personal preference for treatment

Your doctor will take all the above factors into consideration when determining what treatment plan is most appropriate for you.

What Treatments Are Available for Chronic Venous Insufficiency?

There is a spectrum of treatment options available when it comes to chronic venous insufficiency.  Often, treatment will very much depend on how far the condition has progressed.

Lifestyle Changes

There are some steps you can take to improve blood flow in your veins:

• Increase daily activity
• Maintain a healthy weight a diet
• Elevate your legs to increase blood flow and minimize swelling
• Use compression stockings

Medical Treatments

Depending on the severity of your case, many medical treatments are available:

Medicine

Several medicines are helpful for chronic venous insufficiency:

• Diuretics: to draw extra fluid from your body that is then excreted through your kidneys
• Anticoagulants: to thin blood
• Pentoxifylline (Trental): to improve blood flow

Endovenous Laser Ablation or Radiofrequency Ablation (RFA)

RFA and endovenous laser ablation use high-frequency radio waves or laser to create high heat within the diseased vein. Heat is delivered into the vein through a catheter, causing it to shrink and collapse.

Sclerotherapy

In more advanced cases, sclerotherapy is used to treat venous insufficiency symptoms:

A chemical is injected directly into the damaged vein, causing it to shrink and collapse on itself. Blood flow will be redirected to nearby healthy veins. Eventually, the damaged vein will be absorbed by surrounding tissues.

Vascular Surgery

In more severe cases, surgical treatment may be advised:

• Vein stripping (removing) the damaged vein
• Surgical repair of the vein or valves
• Endoscopic surgery: use of a tiny camera that helps the surgeon see and tie off a varicose vein
• Vein bypass: transplanting a healthy vein from another part of your body
• Laser therapy

Chronic Venous Insufficiency Can Be Treated!

If you are worried that you may be suffering from CVI, getting the relief you need is available.  

While CVI is common and not-life threatening, it is a chronic condition that will progress if left untreated.   Often, treatment involves managing your symptoms and preventing further health complications in the future.