Chronic Venous Insufficiency (CVI) – An Overview

What Is Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is a form of venous disease and is a common result of valve dysfunction that occurs when veins in your legs are damaged, are too weak to do their job or don’t function properly.

Normally, valves in your leg veins keep the blood flowing back up to your heart, but with CVI these veins can’t manage the blood flow as well as they should, and it’s harder for the blood in your legs to return to your heart. The result is that the blood begins to pool in your leg veins, leading to high pressure in the veins which causes pain and swelling, may lead to changes in skin color, and increases the potential for blood clots to form and ulcers to develop on your legs.

CVI can occur in any of your leg veins, such as:

Deep veins, which are large veins deep in your body that run through your muscle.
Superficial veins, which are close to the surface of your skin.
Perforating veins, which are the veins that connect your deep and superficial veins.

Chronic Venous Insufficiency vs Acute Venous Disease

Venous diseases can be classified as being either an acute venous disorder or as chronic venous insufficiency. While both forms of venous disease display certain areas of similarity, there are key differences between them.

In general, differences between chronic venous insufficiency and acute venous diseases lies in the duration, the manifestation of symptoms, and the severity of the venous disease.

Acute Venous Disease

Acute venous diseases and disorders frequently arise without any prior medical issues and are more likely to develop as a result of an injury or hereditary traits, combined with acquired risk factors such as lifestyle characteristics. Acute venous disorders generally are not usually life-threatening and long-term effects of acute venous disease are minimal. Furthermore, with prompt, proper treatment acute venous diseases usually do not progress into advanced stages.

Deep vein thrombosis (DVT), which is a blood clot in a deep vein, superficial venous thrombophlebitis (SVT), an inflammation of a superficial vein caused by a blood clot, and venous trauma, which is an injury to a vein, are examples of acute venous diseases. Acute venous disease is characterized by short-term symptoms which last for about 14 days and include sudden swelling, pain, the sensation of tightness or heaviness, and tenderness in the leg. The skin on the affected area may also feel warm to the touch or turn reddish or bluish in color.

Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) develops when the valves that regulate the blood flow back to your heart don’t operate properly, causing the blood to back up into and pool in your legs. Chronic venous insufficiency can cause changes to the skin, leg pain and swelling over time. CVI can also result in severe bleeding and ulcerations around varicose veins, along with open sore on the exterior of the leg, known as venous ulcers to develop.

The severity of these conditions is what causes chronic venous insufficiency to be classified as a chronic venous disease, and the long-term consequences of CVI are significant. Untreated or undiagnosed, chronic venous insufficiency can ultimately be fatal. Chronic venous insufficiency is characterized by long-term symptoms which last well past 28 days and include painful muscle cramps along with pain and spasms in the legs, intensive swelling with discoloration and skin changes, itchiness and irritation combined with hardened skin. Ultimately, venous leg ulcers can develop as an open sore on the exterior of the leg.

Some of the common causes of venous insufficiency include:

Long periods of physical inactivity, or a sedentary lifestyle
Unhealthy eating habits
Smoking
Obesity and an unhealthy body mass index (BMI)
Previous history of blood clots
Weakening of valves due to old age
Fatigued muscles
Pregnancy

What Are The Symptoms Of Chronic Venous Insufficiency

Chronic venous insufficiency may cause mild symptoms at first, but over time, CVI may interfere with your quality of life and ultimately lead to other serious health complications and the symptoms may get worse, or you may notice new symptoms, as your condition progresses.

The symptoms of chronic venous insufficiency appear in your legs and feet, and include:

Leg pain such as aching, heaviness or cramping. The pain may also worsen with standing or sitting.
Swelling in the feet, ankles or lower legs.
Varicose veins, which are enlarged, twisted veins that are visible under the skin.
Skin changes such as discoloration, itching and scaling of the skin.
Fatigue in the legs and even the whole body.
Restless leg syndrome characterized by the urge to move your legs.
Thrombophlebitis, which is the inflammation of a superficial vein, that causes redness, pain and swelling.

Venous Insufficiency Leg Ulcer And Venous Ulcerations

Chronic venous insufficiency is a leading cause of venous ulcers, and specifically venous leg ulcers which are a type of chronic wound. Venous ulcers, also known as venous stasis ulcers, occur when oxygen-poor blood can’t flow from your extremities back to your heart and instead, it pools, creating pressure in your veins. The pooling of this blood damages skin tissue and leads to the development of an ulcer which often occurs on your legs near your ankle.

A venous ulcer is a wound that can take several months to heal and in severe cases, the ulcer never heals. Venous ulcers can worsen quickly, putting you at risk for additional complications that can cause you to lose your limb if undiagnosed and left untreated. In addition to CVI, other causes for venous ulcers include:

High blood pressure (hypertension), which damages blood vessel walls.
Venous obstruction (a vein blockage) that is oftentimes caused by blood clots.
Venous reflux, when blood flows backward through weak or damaged valves.

In addition to a visible shallow wound with irregular borders, symptoms of having a venous ulcer include:

Discoloration of the surrounding skin.
Swelling (edema).
Itching, tingling, heaviness and a dull, painful ache.
Foul odor emitting from the wound site.
Pus or other fluid that oozes from the sore.

How Can Chronic Venous Insufficiency Be Treated

There are several methods for treating chronic venous insufficiency, to include:

Compression therapy
Medications
Nonsurgical treatment
Surgical treatment

Compression Therapy

Generally, compression therapy is the primary and desired method for treating CVI. Using compression therapy helps reduce the swelling and discomfort that is present in your legs. The compression will help your veins “push” the blood back through the venous system to the heart and prevent it from pooling. Compression may be achieve through the use of short stretch compression bandages, compression stockings or compression wraps. Generally these compression therapy products may be purchased without a prescription. If a higher level or more complex method of compression is needed to treat your particular case of CVI, you should consult with your medical professional to ensure that you will have an effective and safe treatment plan to follow.

Medications

Some of the medications which may be prescribed to treat CVI include antibiotics and anticoagulants (blood thinners). The antibiotics can be used to clear skin infections or ulcers caused by CVI, while the anticoagulants can treat existing blood clots and prevent future blood clots from forming. While the use of medications can address the side affects of having CVI, they won’t treat the primary or underlying causes of the disease.

Using a multilayer compression bandage or a medicated wrap known as an Unna boot combine compression along with medication. A multilayer compression bandage combines compression bandages with antimicrobial wound dressings, while the Unna boot is a compression bandage that is impregnated with a zinc oxide paste that forms a semi-rigid medicated bandage which is useful for treating chronic wounds.

Nonsurgical treatment

Nonsurgical treatments for CVI include:

Sclerotherapy, is a minimally invasive procedure where a foam or liquid solution is injected into your spider vein or varicose vein, which causes the vein to collapse or disappear.
Endovenous thermal ablation targets varicose veins through the use of a laser or high-frequency radio waves to create intense heat. This heat closes up the diseased vein but leaves it in place, preventing bleeding or bruising.

Surgical treatment

Surgical treatments for CVI include:

Ligation and stripping, which are two procedures are often performed together. With vein ligation, the problem veins are cut and tied off, while stripping is the surgical removal of larger veins through two small incisions.
Microincision/ambulatory phlebectomy is another minimally invasive procedure that uses a phlebectomy hook to remove varicose veins near the skin’s surface.
Subfascial endoscopic perforator surgery (SEPS) is a minimally invasive procedure that targets your perforating veins above your ankle.
Vein bypass is similar to heart bypass surgery, where part of a healthy vein taken from somewhere else in your body is used to reroute blood around your damaged vein.

How to Prevent or Reverse Venous Insufficiency

There is no full-proof way to prevent chronic venous insufficiency, and once it occurs it cannot be fully reversed. But with proper treatment CVI can be effectively managed. The best approach for managing your CVI will depend on the severity of your particular individual condition. While there are several steps for treating chronic venous insufficiency, any treatment plan will generally include making lifestyle changes or modifications as the first step of treating CVI. This includes:

Leg elevation: Lifting your legs above the level of your heart for 30 minutes or longer at least three times per day can help reduce pressure in your leg veins.

Exercise: Walking and other forms of exercise can help blood flow better in your leg veins. Each time you take a step, your calf muscle squeezes and helps your veins pump blood back up to your heart. This “calf muscle pump” is known as your “second heart.” It helps blood in your legs defy gravity, and it’s vital for your circulation. So, making your calf muscles stronger can help improve your blood flow.

Weight management: Extra weight can put pressure on your veins and damage the valves, therefore it is important to maintain a healthy weight. If you are suffering from CVI, you should consider working with a health care provider or nutritionist to develop a healthy and manageable plan for achieving weight loss and weight management.

You should also consider other contributing factors that raise the risk of developing venous ulcers to help reduce or minimize the risk. The lifestyle factors which may contribute to the development of a venous ulcer include:

Family history of venous disease.
Presence of varicose and spider veins.
Weight and obesity.
Age – older age has a greater risk of developing a venous condition.
Paralysis or a sedentary lifestyle with limited physical activity.
Previous injury.
Smoking habits and history.
Surgery, such as a knee replacement.