Chronic venous insufficiency

Chronic venous insufficiency (CVI) results when the veins in the legs no longer pump blood back to the heart effectively. Normally, when the leg muscles contract, they squeeze the deep veins of the legs, aiding in circulation. Veins contain one-way valves that keep the blood from flowing in the opposite direction, toward the foot. These valves can wear out over time, leading to blood leaking backward and pooling in the veins of the leg. Over time, the veins weaken and stretch. Varicose veins, or superficial veins which are dilated due to faulty valves, can also cause CVI. Blood clots can lead to CVI when they block venous blood-flow or when the clot damages the valves in the veins.

The signs of chronic venous insufficiency are:

• Swelling in the legs and/or ankles (often the first sign)
• Heavy, tight, tired, achy or restless legs
• Varicose veins
• Skin that becomes discolored, feels leathery, flaky and/or itchy
• Ulcers and/or sores that won’t heal

The risk factors for chronic venous insufficiency (CVI) include:

• Age
• Gender
• Obesity
• Pregnancy
• Family history
• Sedentary lifestyle
• Jobs requiring long periods of standing or sitting in one place
• Injury (broken bone) or major surgery on the leg or foot

Chronic venous insufficiency (CVI) is diagnosed using the following:

• Duplex ultrasound: Duplex ultrasound is a type of ultrasound for assessing blood flow and structure of the leg veins.
  
• Magnetic resonance venography (MRV): MRV is a diagnostic procedure that produces detailed, three-dimensional images. Magnetic resonance technology involves the use of magnets, radiofrequencies and computers to produce the images. MRV also includes the use of a contrast dye to help visualize the veins.

Treatment of chronic venous insufficiency (CVI) may not be necessary if symptoms are not bothersome. If treatment is necessary, the focus will be on the three E's: exercise, elevation and elastic compression.

• Exercise: Exercise helps pump blood through the legs and builds muscle that can promote better circulation.
  
  
• Elevation: Elevating the legs can help to instantly relieve pain. A doctor may also instruct a patient to elevate the legs above the heart three or four time a day for about 15 minutes at a time. This can help to reduce swelling. If prolonged standing or sitting is necessary, bending the legs several times will help promote blood circulation.
  
  
• Elastic compression: Elastic compression stockings increase in tightness from the toes to the calves. They squeeze the leg veins, exerting additional pressure that helps to prevent blood from flowing backwards.

If the three E's don't substantially relieve bothersome symptoms, CVI may also be treated in the following ways:

Minimally invasive treatments

If CVI is caused by reflux in superficial veins, treating these veins may help with symptoms. Recovery from these outpatient procedures is usually on the order of days.

• Radiofrequency closure: A catheter is placed in the greater saphenous vein, the largest superficial vein in the medial thigh, and radiofrequency waves are released, providing heat that destroys the vein tissue. The vein is scarred closed.
  
  
• Endovenous laser therapy: A thin laser optic fiber is inserted through a catheter in the greater saphenous vein. Laser energy is delivered through the tip that destroys the diseased portion of the vein. The vein is scarred closed.

Angioplasty and stent placement

If a blocked vein is causing CVI, angioplasty and stent placement may be used. (See chronic limb ischemia.)

Surgical treatment: venous stripping

This procedure involves the removal of the greater saphenous vein, the largest superficial vein along the inner thigh. It is removed through a small groin incision and a small incision near the knee.