When the symptoms and disability caused by venous disease are continuous and difficult to handle, it is called chronic venous insufficiency (CVI), chronic venous disease (CVD), or post-phlebitic syndrome. Veins are responsible for carrying oxygen-depleted blood back to the heart to be reoxygenated. There are tiny valves that prevent the blood from flowing backward, away from the heart. In the legs, these valves must work against gravity, especially if you stand a lot. CVI occurs when the valves inside the veins are no longer capable of doing their job.
Our doctors can perform a minimally-invasive procedure called endovenous ablation that closes off the damaged veins. The closed veins are then reabsorbed by the body, forcing healthy veins to take over their function so that your legs are free of pain and you can resume your normal activities.
Symptoms and Signs
When the valves can't prevent blood from flowing downward into the legs, blood will pool in the legs. The symptoms of CVI include swelling, feelings of heaviness or fullness, and pain in the legs. Often these symptoms are relieved by elevating your legs and resting. In severe cases of CVI, the skin can be affected by discoloration or changes in skin texture or ulcers that don't heal.
In summary, the symptoms and signs of CVI are as follows:
Symptoms
- tight-feeling calves
- legs may feel heavy, tired, achy, or "full"
- pain while walking
- pain shortly after you stop walking
- pain can be relieved by resting and elevating legs
Signs
- swollen ankles or legs
- varicose veins
- leg rashes, redness, or sores
- leathery leg skin
- non-healing open sores (ulcers)
Symptoms are indicators of a disease that you experience, while signs are indicators of a disease that can be seen. Your doctor will ask you about the symptoms you experience and examine you for signs.
Diagnosis
Diagnosis of chronic venous insufficiency is done by discussing your symptoms with you, then performing a painless duplex ultrasound test to view the blood flow in your legs to determine if the blood is compromised. It also checks for the presence of blood clots, which would indicate deep vein thrombosis (DVT).
Treatment
Chronic Venous Insufficiency is not necessarily a health risk. Treatment generally focuses on reducing pain and decreasing disability due to symptoms of CVI. Fewer than 10% of people with CVI will require invasive procedures to provide symptom relief.
Treatment for Mild CVI
Mild cases of CVI are treated with compression stockings, which are simply elastic stockings that apply pressure to your veins to prevent blood from running backward. You can also avoid leg swelling by raising your legs to reduce pooling. You should avoid standing for long periods, but if you must, you should flex your leg muscles occasionally to encourage the blood to keep moving. These steps can prevent new symptoms from occurring, allow lesions and ulcerations to heal, and avoid worsening of the condition.
Treatment for Moderate to Severe CVI
If your doctor feels that your CVI has progressed far enough that you require some kind of intervention to protect your health and avoid amputation, you have several options:
Endovenous Ablation
Our doctors perform endovenous ablation. Endovenous ablation is a minimally-invasive technique that uses a tiny catheter to reach the damaged vein. Heat or lasers are then applied to the vein to seal it off. This prevents blood from flowing through them, so that healthy veins can take over to allow the blood to return to the heart normally. The destroyed vein will eventually be absorbed by the body.
Sclerotherapy
Sclerotherapy is similar to ablation, but treats the weakened veins by injecting a chemical into the damaged veins, rather than using heat or lasers.
Vein Stripping
In vein stripping, all minor veins attached to the greater saphenous vein (the main superficial vein in the leg) are tied off and the saphenous vein is removed. Healthy minor veins take over the saphenous vein's function. A small incision at the groin and a small incision in your calf are necessary to perform this procedure.
Valve Repair
Valves can be repaired by folding or tucking the valve flaps. A sleeve may be placed around the affected vein to press the valves closer together so they can more effectively keep the blood from pooling.
Bypass
The most severe cases of CVI, those which affecting the upper thigh or pelvis, require bypass surgery. The surgeon uses an artificial vein or a healthy vein transplanted from somewhere else in your body to help blood flow around the damaged vein. There is a slight chance of DVT with surgery like this, so your physician will only recommend this procedure if none of the other options will help you.
Complications
Deep Vein Thrombosis (DVT)
The blood pooling in the veins of the leg can create an environment that can cause deep vein thrombosis (DVT), in which blood clots form and potentially block blood flow within the veins. DVT can also cause potentially fatal pulmonary embolisms if a blood clot breaks loose and travels up toward the heart and gets lodged in the veins of the lung.
Ulcerations
Venous ulcers caused by CVI are usually located around the feet and ankles. They are caused by a lack of circulation, compounded by lymphatic secretions. Ulcers can be very difficult to heal and require careful care and supervision.
Risk Factors
- deep vein thrombosis
- family history of varicose veins
- being overweight
- being pregnant
- not getting enough exercise
- standing or sitting for long periods
- being female
- being over 50