Veins return blood to the heart from all the body’s organs. To reach the heart, the muscles in your calves and feet need to contract with each step to squeeze the veins and push the blood upward toward your heart. To keep the blood flowing up, and not back down, the veins contain one-way valves.
What is chronic venous insufficiency (CVI)?
Chronic venous insufficiency (CVI) is a condition when the walls of the veins and/or valves in your leg veins do not work the way they should. This makes it hard for blood to move to your heart from the legs. Blood collects (pools) in these veins, which is called stasis.
What causes chronic venous insufficiency?
CVI is caused by damage to the valves inside your leg veins. When the valves are damaged, the blood can leak backward. Valve damage can be caused by aging, long periods of sitting or standing, or a combination of aging and lack of movement. When the veins and valves become so weak it is hard for blood to flow up to the heart, the blood pressure in the veins stays high for long periods of time. This leads to CVI.
CVI may be caused by a blood clot in the deep veins of the legs (deep vein thrombosis/DVT). When this is the cause, it is called post-thrombotic syndrome. As many as 30% of people who have a DVT develop CVI within 10 years. The condition can also be caused by pelvic tumors, vascular malformations, and sometimes the cause is unknown.
What are the symptoms of chronic venous insufficiency?
Symptoms of CVI get worse with time. This is why it is very important to see your doctor if you have any symptoms of CVI. Waiting to be seen can cause the condition to get worse and lead to complications.
Symptoms of CVI include:
- Leg cramps.
- Swelling in the lower legs and ankles, especially after standing for a long time.
- Aching or tiredness in the legs.
- New varicose veins.
- Leathery-looking skin on the legs.
- Skin appearing brown or red.
- Flaking or itching skin on the legs or feet.
- Open sores on your legs (venous stasis ulcers).
- Heavy feeling in your legs.
Without treatment, the pressure and swelling in the veins build up and cause tiny blood vessels (capillaries) to burst. When this happens, the area of skin in your leg turns reddish-brown color and can easily break open if you bump or scratch it.
This causes swelling and damage of the tissue inside your legs. It can also cause open sores on your skin (venous stasis ulcers). It can be very difficult for the ulcers to heal, which can lead to infection. If the infection is not controlled, it can spread to surrounding tissue, a condition known as cellulitis.
Patients with CVI often have varicose veins, which are twisted, enlarged veins close to the skin’s surface. They can occur almost anywhere, but are most common in the legs.
What are the risk factors for CVI?
If you have risk factors for CVI, you are more likely than other people to develop the disease. The most important risk factors are:
- Deep vein thrombosis (DVT).
- Varicose veins or a family history of varicose veins.
- Obesity.
- Pregnancy.
- Inactivity.
- Smoking.
- Extended periods of standing or sitting.
- Age over 50.
How common is CVI?
About 40% of people in the United States have CVI. The condition is more common in women and people over age 50.
How is CVI diagnosed?
If you have symptoms of CVI, your doctor will talk to you about your symptoms, medical history and examine you, paying special attention to your legs. This is often enough to know if you have the disease.
You may have a vascular or duplex ultrasound to check 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 sends sound waves that bounce off the vein, which create an image of the veins.
What treatments are available for patients with CVI?
It is best to start treatment as soon as possible. Most often, treatment involves a combination of:
- Avoiding long periods of standing or sitting: If you must take a long trip and will be sitting for a long time, flex and extend your legs, feet, and ankles about 10 times every 30 minutes to keep the blood flowing in the leg veins. If you need to stand for long periods of time, take frequent breaks to sit down and elevate your feet above heart-level.
- Regular exercise: 30 to 60 minutes of aerobic exercise five to six times per week. Walking is especially helpful.
- Lose weight if you are overweight. Goal is a BMI of 25 or lower.
- Elevate your legs above heart-level while sitting and lying down.
- Wear graduated compression stockings. Be sure to get measured for these to make sure you wear the right size.
- Take antibiotics as needed to treat skin infections.
- Practice good skin hygiene. Wash your legs with soap and water every day. Keep your legs hydrated with moisturizer to prevent skin breakdown.
The goals of treatment are to reduce the pooling of blood and prevent leg ulcers.
Graduated compression stockings
The most conservative approach is to wear properly fitting support hose (also called graduated compression stockings). You can buy these at some pharmacies and medical supply stores and come in various styles. Your doctor can recommend the right size and type for you. Wearing stockings that are the wrong size can actually lead to more problems. Wash your stockings at the end of the day and clean and check your skin.
Antibiotics
If you have a skin infection, you may need an antibiotic.
Other medications
If you have post-thrombotic syndrome, you may need medication to prevent blood clots.
Skin care
Good skin hygiene is important. Keep your skin moisturized so it does not flake or crack easily. If your skin is not broken or leaking fluid but is inflamed, you may need an anti-itch cream, such as hydrocortisone; a cream containing zinc oxide to protect the skin; or an antifungal cream to prevent fungal infections.
Skin that is leaking fluid is treated with wet compresses. If you have ulcers on your legs, your doctor will show you how to apply layered compression bandages to protect the skin and maintain blood flow.
Nonsurgical treatments
Nonsurgical treatments include sclerotherapy and endovenous thermal ablation. An ultrasound can help determine the best treatment for you.
Sclerotherapy involves the injection of a solution directly into the veins that stops the blood flow in the vein. Sclerotherapy is simple, relatively inexpensive, and can be performed in the doctor’s office.
Endovenous thermal ablation uses a laser or high-frequency radio waves to create intense local heat in the affected vein. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising.
When is surgery needed?
Less than 10% of patients with CVI need surgical treatment. Surgical options include vein ligation and stripping, microincision/ambulatory phlebectomy, and bypass surgery.
Ligation and stripping are often done together. Vein ligation involves cutting and tying off the problem veins. Recovery time is relatively quick. Stripping is the removal of larger veins. This is done through two small incisions. Recovery can take up to 10 days.
Microincision/ambulatory phlebectomy is a minimally invasive procedure in which small incisions or needle punctures are made over the veins, and a phlebectomy hook is used to remove the problem veins.
Vein bypass in the leg is similar to heart bypass surgery. It involves using a piece of a healthy vein from another area of your body to reroute blood around the problem vein. Bypass is used for treatment of CVI in the upper thigh and only in the most severe cases, when no other treatment is effective.
Can CVI be prevented?
To reduce your risk of developing CVI, follow these guidelines:
- Eat a healthy balanced diet.
- Quit smoking.
- Exercise regularly.
- Avoid wearing tight clothing (i.e. girdles, belts).
- Lose weight (if you are overweight).
- Avoid long periods of sitting and standing.
