Chronic Venous Insufficiency (CVI) occurs when the valves of the vein do not function properly, impairing blood circulation in the leg veins. Vein blockage or damaged valves in the vein can lead to CVI. This can occur due to blood clots in the deep veins of your legs, a condition known as deep vein thrombosis (DVT). However, the risk of DVT is low when a blood clot forms in the superficial veins, ones that lie close to the skin.
Understanding the Condition
Causes of Chronic Venous Insufficiency
Blood flows back from the legs to the heart through vein valves. When the valves don’t function properly, they fail to close, reversing the flow of blood (venous reflux). This arises when the vein wall becomes weak. If one has a history of blood clots, or if vein valves are absent at birth, the valve thus gets damaged from DVT.
Faulty valves increase pressure inside your leg, causing high blood pressure in the vein. It leads to an enlargement of varicose veins, and other symptoms such as swelling, pigmentation changes, and sores or ulcers on the ankle or lower leg.
Unfortunately, venous reflux is progressive and may lead to advanced symptoms, even affecting the pelvis. Vein blockage in the pelvis may further worsen varicose vein symptoms and require separate treatment.
CVI may be asymptomatic and pose no immediate health concerns. When symptoms are present, the common ones experienced are heaviness, pain, fatigue, throbbing, burning, itching, and muscle cramping.
Over time, CVI may result in varicose veins, characterized by ankle and foot swelling on the lower leg. In severe cases, the skin may break down and the varicose veins may bleed. When blood clots form in the veins, quick medical attention becomes important.
The prevalence of CVI ranges from 25-40% in women and 10-20% in men. Family history may play a role. Women over the age of 50 and those who have had multiple pregnancies may be predisposed to the condition.
Other risk factors include a sedentary lifestyle, obesity, high blood pressure, and clots in deep or superficial veins.
- Physical examination
- Doppler ultrasound to listen to blood flow and determine venous reflux
- Venous duplex ultrasound scan to view blood clots
- CAT scan or MRI to exclude other causes of leg pain and swelling
Treatment of Chronic Venous Insufficiency
Treatment will depend on the severity of CVI. Lifestyle and diet changes, avoiding prolonged sitting or standing, and exercises to strengthen calf muscle function may be recommended. You may need to wear compression stockings to halt the reverse flow of blood and heal skin sores.
For severe cases, sclerotherapy is an option. It involves injecting a chemical into the faulty veins to scar them from within and prevent blood from pooling these defective veins. Surgical interventions for CVI are ablation, where a catheter is used to destroy vein tissues, and angioplasty with stenting, where blocked or narrowed sections of the vein are enlarged and a metal stent is put in place to keep the sections open.