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What is chronic insufficiency (CVI) is an ailment that occurs when the venous wall and /or valves in the leg veins are not operating properly, making it challenging for blood to revert to the heart from the legs. CVI causes blood to “pool” or accumulate in these veins; the pooling is called stasis.
What causes chronic venous insufficiency?
Veins return blood to the heart from the rest of the body’s organs. To reach the heart, the blood must flow upward in the body from the veins in the legs. Calf muscles and the muscles in the feet must contract with each step to compress the veins and push the blood higher. To keep the blood flowing up, and not back down. The veins comprise one-way valves.
Chronic venous insufficiency happens when these valves become damaged, enabling the blood o leak backward. Valve damage can occur as the result of aging, prolonged sitting or standing or a mixture of aging and reduced movement. When the veins and valves are weakened to the point where it is challenging for the blood to flow up into the heart, blood pressure in the veins remains elevated for extended periods of time, leading to CVI.
CVI is most commonly present as a result of a blood clot in the deep veins of the legs, a disease identified as deep vein thrombosis (DVT). CVI also is a result from pelvic tumors and vascular malformations and sometimes occur for unknown reasons. Sluggish movement of blood out of veins can lead to swollen legs, due to the failure of the veins within the legs to hold blood against the pressure of gravity.
Chronic venous insufficiency that begins from DVT is also referred to as post-thrombotic syndrome. Nearly 30 of people with DTV develop post-thrombotic syndrome within ten years of a diagnosis of DVT.
What are the risk factors of chronic venous insufficiency
If you have risk factors of CV your are more likely than others to develop the disease. These risk factors include:
- Female gender
- Age over 50
- Varicose veins or a family history or varicose veins
- Deep vein thrombosis (DVT)
Who is affected by chronic venous insufficiency?
It is estimated that 40 percent of people in the United States have CVI. It happens more commonly in people over age 50, and more frequently in women than in men.
The importance of CVI, along with the complexities of treatment, increase as the disease progresses. That is why is very critical to see your doctor if you see any symptoms of CVI. The problem will not be degrees if you wait. The chances of preventing severe complications improve if you are treated earlier.
- Aching or tiredness in the legs
- New varicose veins
- Lathery-looking skin on the legs
- Stasis ulcers
- Itching skin or Flaking skin on the legs or feet
- Swelling in the lower legs and ankles, especially after extended periods of standing
If CVI is not managed, the pressure and swelling increase util the tiniest blood vessels in the legs (capillaries) burst. When this occurs, the over skin takes on a reddish-brown color and is very sensitive to being broken if bumped or scratched.
Capillaries that are burst can cause local tissue inflammation and internal tissue damage. In more serious cases, this leads to ulcers, open sores on the skin exterior. These venous stasis ulcers can be challenging to heal and can become infected. When the infection is not managed, it can expand to surrounding tissue, a condition known as cellulitis.
CVI is often associated with varicose veins; which are twisted. Enlarged veins close to the surface of the skin. They can happen almost anywhere, but most often occur in the legs.
How is CVI diagnosed
To diagnose CVI, your physician will perform a complete medical history and physical examination. During the physical examination, your doctor will examine your legs. A test referred to as a vascular, or duplex ultrasound might be used to measure the blood flowing in your legs. In the vascular ultrasound, a transducer ( small hand-held device) is located on the skin over the vein to be examined. The transducer emits sounds waves that bounce off the vein. These sound waves are recorded, and an image or the vessel is created and displayed on a monitor.
How can you chronic venous insufficiency treated or managed?
Similar to other disordersCVI is is easier to treat successfully in the earlier stages. Vascular medicine or vascular surgery specialists recommend a combination of treatments for people with CVI.Some of the basic treatment strategies include:
Avoid extended periods of standing sitting: If you must take a long trip and will be sitting for a long time, you should extend and flex your legs, ankles and feet about ten times every 30minutes to keep the blood flowing in the leg veins. If you need to stand for extended periods of time, take routine breaks to sit down and elevate your feet.
- Exercise regularly – Walking is especially beneficial.
- Lose Weight if you are overweight
- Elevate your legs while sitting and laying down, with your legs raised above the level of your heart
- Take antibiotics as required to treat skin infections
- Practice good skin hygiene
- Wear Compression Stockings
The most conservative approach is to wear properly -fitting support hose ( called compression stockings). Compression stockings can be purchased at some pharmacies and medical supply stores and come in various styles, including below-the-knee, above -the-knee and pantyhose styles. They also come in various compressions varying from 8 to 10 mm Hg, up to 40 to 50 mm Hg. Your doctor can suggest the compression that is right for you. You will need a prescription for any socks with more than 20 mm HG compression.
If you wear compression stockings, you should be sure to take them off at the end of the of the day to wash and dry them, and to clean and check your skin. You should make sure the stockings fit, so there is no bunching. Elastic stockings that fit poorly can worsen the condition by blocking blood flow to the area where they have bunched up.
Some studies have shown that mixing elastic socks with prescription medication to improve blood flow is very efficient when the socks alone do not control symptoms.
Antibiotics may be prescribed to clear skin infections related to CVI, but the underlying disease must be treated to prevent a recurrence. Deeper infections and ulcer may also be treated with antibiotics.
If you have a post-thrombotic syndrome, you doctor may prescribe medication to block the formation of additional blood clots.
A specific medicated wrap, known as an Unna Boot, joins multilayer compression with a zinc oxide gel-based wound covering that forms a semi-rigid bandage. Other multilayer squeezing systems are available and are often used in combinations with topical wound care products.
Some patients have obtained benefit from the herbal dietary supplement Vena-Stat, which contains a derivative of horse chestnut extract. You should not use herbal preparations in place of your prescription medications and should be used with caution, as they can interact with current prescription medications. You should inquire with your doctor or pharmacist about any drug interaction.
Practicing good skin hygiene is critical to prevent infections. You should keep your skin moisturized, so that does not flake or crack easily. If the skin is not punctured or leaking fluid but is swollen, your doctor may recommend an anti-itch cream, such as one that as hydrocortisone as a component, a cream containing zinc oxide to shield the skin or an antifungal salve to inhibit fungal infections.
Skin that is oozing fluid is treated with wet compresses. If you have ulcers on your legs, your physician will teach you how to implement layered compression bandages to shield the skin and maintain blood flow.
Nonsurgical treatments involve sclerotherapy and-and endovenous thermal ablation.
Sclerotherapy involves the injection of a solution directly into the spider veins or small varicose veins that cause them to collapse and disappear. Several sclerotherapy treatments are normally required to achieve the-the desire results. Sclerotherapy is simple, relatively inexpensive and can be performed in the doctor’s office. Sclerotherapy can eliminate the pain and distress of these veins and helps prevent complications such as venous hemorrhage and ulceration. It is also frequently performed from cosmetic reasons.
Endovenous thermal ablation is a unique technique that utilizes a laser or high-frequency radio waves to produce powerful local heat in the affected vein. The technology differs with each energy source. However, both forms of local heat local heat close up the targeted vessel. This approach closes off the problem veins but leaves them in place, so there are the smallest bleeding and bruising compared with ligation and stripping, endovenous thermal ablation outcomes are less pain and faster return to normal activities, with similar results.
When is surgical treatment necessary
Surgery may be required for around 10% of patients who require surgical treatment; the options include vein stripping and vein ligation, bypass surgery, microincision/ambulatory phlebectomy.
Vein Stripping and Ligation is performed in combination. Vein ligation is produced in which a vascular surgeon severs and ties off the problem veins. Most patients recover within a few days and can start their regular activities. Stripping is the surgical removal of larger veins through small incisions. Stripping is a more extensive method and may require up to 10 days for recovery. It usually causes bruising for several weeks after surgery.
Vein bypass is a procedure similar to heart bypass surgery, just in a different location. It includes using a portion of the healthy vein, removed from other places in your body to reroute blood around the vein affected by CVI. Vien bypass is a treatment option for CVI in the upper thigh and is use in only the most severe cases, when no other treatment, can be effective.
Microincision /ambulatory phlebectomy is minimally invasive procedure in which small incisions or needle punctures are made over the veins and the phlebectomy hook to remove problematic veins.
- Can chronic venous insufficiency be prevented?
- Avoid long periods of standing or sitting
- Exercise regularly
- Stop Smoking
- Exercise Regularly
- Eat a healthy balanced diet.