Chronic Venous Insufficiency (CVI)

What is Chronic Venous Insufficiency?

Chronic Venous Insufficiency or CVI is a medical condition that happens when the non-oxygenated blood stream back to the heart does not flow freely due to ineffective work of the venous wall and/or venous valves. This allows the blood to leak backward. In the end, it results to pooling of blood in the veins, or venous stasis.

This is long-standing condition, but treatable at early detection.

Causes

Veins are pathways of non-oxygenated blood returning to the right atrium of the heart from other organs of the body. Anatomically, what defers veins from artery, veins has one-way valves. These valves keep the blood continually flowing, but controlled.

There are many of reasons why chronic venous insufficiency occurs. CVI happens when these valves are damaged, resulting to the back-flow of the non-oxygenated blood. This by then causes stasis of the blood.

Damaged veins develop as a result of extended periods of sitting or standing, or combination of aging and reduced mobility.

Other risk factors in developing CVI include being female due to the presence of hormonal level of progesterone, obesity, being tall as well as pregnancy.

CVI is also commonly caused by blockage in the vein from a clot. This happens normally on patients diagnosed with deep vein thrombosis or DVT.

Chronic venous insufficiency developed after deep vein thrombosis is medically termed as post-thrombotic syndrome. Study shows that approximately 30% diagnosed with DVT usually develop CVI later within 10 years after diagnosis.

Damaged veins like that of varicose veins rarely results to chronic venous insufficiency.

Another common cause of CVI is congenital absence of venous valves. Pelvic tumours and vascular formation adds in the development of CVI. This however, happens for unknown reasons.

Signs & Symptoms

It is important to be keen observant once known to have the risks in developing chronic venous insufficiency. Once one must see signs and symptoms and report immediately to medical practitioners for medical diagnosis and prompt medical treatment be rendered.

Signs and symptoms include:

1. Tiredness in the legs
2. Pain while walking or shortly after walking
3. Superficial varicose veins: blue, bulging and twisted
4. Swelling and redness in the lower legs and ankles, common after prolonged standing: due to pressure on blood pooling in the vein
5. Venous stasis ulcers on legs and ankles
6. Thickening and hardening of the skin on the legs and ankles/ leather-looking skin (lipodermatosclerosis)

Treatment

Chronic Venous Insufficiency is treatable in its earliest stage. Specialist would recommend combination of treatment of vascular medicine and vascular surgery. There are basic treatment strategies that prevent pooling or stasis of blood in the veins. These include:

1. Avoid prolonged standing or sitting. One must take a few breaks in between. Do leg and ankle exercise – flex, dorsi-flex and rotate ankle for 10 minutes every 30 minutes; if standing for long periods, take a break to sit down and elevate legs above heart level.
2. Eat healthy balanced diet. Avoid junk foods and fatty foods. Eat fruits and vegetables.
3. Stop smoking. Components in cigarette constrict blood vessels.
4. Lose weight if overweight. Monitor your body mass index.
5. Exercise regularly. There’s no easy way than walking. Walking is highly recommended, walking for 30 minutes is beneficial enough.
6. Elevate legs. This is to promote blood flow while sitting or lying down for extended periods, position above the level of the heart. It would be better to elevate legs not more than 90 degrees for 10 -15 minutes.
7. Wear compression stockings. It is also called as anti-embolic stocking, use it especially on long periods of lying down or sitting. Wear it in the morning before getting out of the bed. This squeezes the veins and prevents non-oxygenated blood stream backward. It is also help heal skin sore and avoids from developing it again.
8. Religiously take medications as doctors prescribed. Antibiotics are ordered for infection and prevention of its recurrence. This is also used in treating ulcers.
9. Patients with history of post-thrombotic syndrome are treated with anticoagulants. This aids in the prevention in the formation of blood clots.
10. Skin Care and Proper hygiene. Proper hand hygiene is most important. This helps prevent infection. Keeping skin moisturized prevents skin from itchiness and flakiness. Physician may prescribe cream containing zinc oxide to protect the skin.

In intensive cases, nonsurgical and surgical treatment may be an option.

Nonsurgical Treatment for Chronic Venous Insufficiency

1. Sclerotherapy : A solution is directly injected to an affected varicose vein. This causes the vein to collapse and disappear. Several sclerotherapy treatments may be done to achieve desired outcome. This can be done in physician’s clinic. It is also inexpensive. It relatively relieves pain and discomfort and lessens the possibility of haemorrhage.
2. Endovenous thermal ablation. Using high-frequency waves or laser, it creates intense heat on the walls of the varicose veins and eventually destroys vein tissue that is gradually absorbed by the body.

Surgical Treatment for Chronic Venous Insufficiency

1. Ligation and stripping. This is usually done together. Ligation is cutting of the vein and tying both ends. Recovery is fast. Stripping is done by removing larger veins through smaller incisions. It is more extensive and causes bruises days after surgery.
2. Bypass. This is done only in intense condition when other treatment found ineffective. Like heart bypass, healthy vein from other part of the body and transplanted to the affected area connecting left healthy veins and rerouting blood flow continuously.

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