Chronic venous insufficiency (CVI) is a long-term condition in which the veins in the legs are unable to efficiently return blood to the heart. This occurs due to damage or malfunction of the valves in the leg veins, which are responsible for keeping blood moving in the correct direction—toward the heart. When these valves fail, blood can flow backward (a process called venous reflux), leading to blood pooling in the legs and increased pressure in the veins.
Causes and Risk Factors:
- The most common cause of CVI is damage to vein valves from deep vein thrombosis (DVT), which is a blood clot in one of the deep veins.
- Other causes include:
- Contributing risk factors:
Symptoms:
- Leg pain, dull aching, heaviness, or cramping
- Swelling of the legs and ankles
- Visible varicose veins
- Skin changes: itching, redness, thickening, hardening (lipodermatosclerosis), or discoloration
- Stasis dermatitis (red, crusty, or weepy skin)
- Leg ulcers or open sores that heal slowly, especially near the ankles
Symptoms often worsen after prolonged standing and may improve when legs are elevated. If untreated, CVI can lead to chronic skin changes and ulcerations, which may be painful and disabling but are rarely immediately life-threatening.
Diagnosis:
- Primarily through physical examination and duplex ultrasound, which assesses blood flow and looks for blood clots or valve problems.
- In more severe or ambiguous cases, additional imaging like CT or MRA scans may be used.
Treatment:
- Lifestyle modifications: weight loss, leg elevation, regular exercise, and avoiding prolonged standing/sitting.
- Compression therapy: wearing compression stockings to help blood return toward the heart.
- Medications or topical treatments for skin complications if needed.
- Procedures or surgery: For advanced cases, options include minimally invasive procedures like endovenous laser treatment for varicose veins or procedures to address vein blockage or remove faulty veins.
- The choice of treatment depends on symptom severity, underlying causes, and the presence of other health conditions (such as peripheral artery disease).
Epidemiology:
- CVI is more common in women and generally increases with age.
- In the U.S., millions are affected, with advanced CVI present in over 2 million people, and more than 20,000 are diagnosed with related ulcers each year.
Key Points:
- CVI is a common, often progressive condition that most frequently affects the legs due to gravity and the distance from the heart.
- Early recognition and management are crucial to prevent complications and improve quality of life.
If you have symptoms suggestive of CVI, consulting a healthcare provider for appropriate diagnosis and management is advised.
