Varicose Veins & Chronic Venous Insufficiency and Treatment, Douglas Joseph, DO

What is chronic venous insufficiency (CVI)?

Chronic venous insufficiency (CVI) is a condition that occurs once the venous wall surface and/or valves in the leg veins space not working effectively, make it complicated for blood to return to the love from the legs. CVI reasons blood come “pool” or collection in this veins, and this pooling is referred to as stasis.

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Valve inside Vein

What reasons chronic venous insufficiency?

Veins return blood come the love from all the body’s organs. To reach the heart, the blood demands to flow upward native the veins in the legs. Calf muscles and also the muscles in the feet need to contract through each step to squeeze the veins and also push the blood upward. To save the blood flowing up, and not back down, the veins contain one-way valves.

Chronic venous insufficiency occurs once these valves come to be damaged, allowing the blood to leak backward. Valve damage may happen as the result of aging, extended sitting or standing or a combination of aging and reduced mobility. When the veins and also valves space weakened to the point where that is complicated for the blood to flow up to the heart, blood press in the veins remains elevated for long periods that time, bring about CVI.

CVI most frequently occurs as the an outcome of a blood clot in the deep veins of the legs, a disease known as deep vein thrombosis (DVT). CVI also results native pelvic tumors and also vascular malformations, and sometimes occurs because that unknown reasons. Failure of the valves in leg veins to host blood versus gravity leader to sluggish movement of blood out of the veins, resulting in swollen legs.

Chronic venous insufficiency that creates as a result of DVT is likewise known together post-thrombotic syndrome. As numerous as 30 percent of civilization with DVT will construct this trouble within 10 years after diagnosis.

Who is affected by chronic venous insufficiency?

An approximated 40 percent of human being in the united States have CVI. The occurs much more frequently in civilization over age 50, and an ext often in women than in men.

Symptoms and Causes


What are the symptom of chronic venous insufficiency?

The seriousness that CVI, in addition to the complexities that treatment, increase as the condition progresses. It is why that is an extremely important to see your physician if you have any type of of the symptoms of CVI. The trouble will no go away if you wait, and also the previously it is diagnosed and treated, the better your possibilities of staying clear of serious complications.Symptoms include:

Swelling in the lower legs and ankles, especially after expanded periods that standingAching or fatigue in the legsNew varicose veinsLeathery-looking skin top top the legsFlaking or itching skin ~ above the foot or feetStasis ulcers (or venous stasis ulcers)

If CVI is no treated, the pressure and swelling rise until the tiniest blood ship in the foot (capillaries) burst. When this happens, the overlying skin take away on a reddish-brown color and is very sensitive to being broken if bumped or scratched.

At the least, burst capillaries can reason local tissue inflammation and also internal tissue damage. At worst, this leader to ulcers, open sores top top the skin surface. This venous stasis ulcers can be challenging to heal and also can come to be infected. When the epidemic is not controlled, it have the right to spread to neighboring tissue, a problem known together cellulitis.

CVI is often linked with varicose veins, which room twisted, enlarged veins close to the surface of the skin. They have the right to occur almost anywhere, but most typically occur in the legs.

Diagnosis and Tests

How is CVI diagnosed?

To diagnose CVI, your doctor will carry out a complete medical background and physical exam. Throughout the physics exam, the medical professional will closely examine your legs.A test called a vascular or duplex ultrasound might be offered to study the blood circulation in her legs. Throughout the vascular ultrasound, a transducer (small hand-held device) is inserted on the skin over the vein to be examined. The transducer emits sound waves the bounce off the vein. This sound waves are recorded, and an image of the ship is created and displayed top top a monitor.

Management and also Treatment

How is chronic venous insufficiency treated or managed?

Like any type of disease, CVI is many treatable in its earliest stages. Vascular medicine or vascular surgical procedure specialists typically recommend a combination of therapies for human being with CVI. Some of the simple treatment techniques include:

Avoid long periods of was standing or sitting: If you need to take a long trip and also will be sitting because that a long time, flex and also extend her legs, feet, and ankles about 10 times every 30 minute to keep the blood flow in the foot veins. If you must stand for lengthy periods that time, take frequent breaks to sit down and also elevate your feet.Exercise regularly. wade is especially beneficial.Lose weight if you space overweight.Elevate her legs if sitting and also lying down, with your foot elevated above the level of her heart.Wear compression stockings.Take antibiotics as required to law skin infections.Practice good skin hygiene.

The goals of treatment room to minimize the pooling that blood and prevent foot ulcers.

Compression Stockings

The most conservative strategy is to wear properly-fitting support hose (also dubbed compression stockings). Compression stockings can be purchase at part pharmacies and also medical it is provided stores and also come in various styles, consisting of below-the-knee, above-the-knee and pantyhose styles. They also come in different compressions differing from 8 come 10 mm Hg, as much as 40 to 50 mm Hg. Her doctor have the right to recommend the compression that is right for you. You will need a prescription for any kind of stockings with an ext than 20 mm Hg compression.

If you wear compression stockings, be sure to take it them turn off at the finish of the day to wash and also dry them, and also to clean and check your skin. Make certain the stockings fit so over there is no bunching. Elastic stockings the fit poorly can actually make your condition worse by prevent blood flow in the area whereby they have bunched up.

Some research studies have shown that combining elastic socks through prescription medication to enhance blood circulation is an extremely effective as soon as the socks alone perform not manage symptoms.



Antibiotics may be prescribed to clean skin infections regarded CVI, however the underlying disease must be treated to protect against a recurrence. Deeper infections and also ulcers may additionally be treated through antibiotics.

Other Medications

If you have actually post-thrombotic syndrome, her doctor might prescribe medication to prevent the development of extr blood clots.

A unique medicated wrap, recognized as one Unna Boot, combine multilayer compression v a zinc oxide gel-based wound sheathe that creates a semi-rigid bandage. Various other multilayer compression solution are available and are regularly used in mix with topical wound care products.

Some patients have actually found advantage from the herbal dietary complement Vena-Stat, which consists of a derivative of equine chestnut extract. Save in mind that natural preparations should not be used in location of your prescription medications and also should be used with caution, as they may interact with current prescription medications. You re welcome ask your medical professional or pharmacist around any potential drug interactions.

Skin Care

Practicing great skin toilet is important. Save your skin moisturized so the it no flake or cracked easily. If the skin is not damaged or leaking fluid yet is inflamed, your doctor might recommend one anti-itch cream, such together one comprise hydrocortisone; a cream comprise zinc oxide to defend the skin; or an antifungal cream to prevent fungal infections.

Skin that is leaking liquid is treated with wet compresses. If you have ulcers on your legs, your physician will show you just how to apply layered compression bandages to safeguard the skin and also maintain blood flow.

Nonsurgical Treatment

Nonsurgical treatments include sclerotherapy and endovenous heat ablation.

Sclerotherapy requires the injection that a solution directly into spider veins or little varicose veins that causes them come collapse and also disappear. Number of sclerotherapy treatments space usually forced to achieve the wanted results. Sclerotherapy is simple, fairly inexpensive, and also can it is in performed in the doctor’s office. Sclerotherapy can get rid of the pain and discomfort of these veins and also helps prevent complications such as venous hemorrhage and ulceration. It is likewise frequently performed for cosmetic reasons.

Endovenous heat ablation is a newer method that provides a laser or high-frequency radio waves to develop intense local warmth in the affected vein. The technology is various with each energy source, yet both forms of local heat close up the target vessel. This therapy closes turn off the problem veins but leaves castle in place so over there is minimal bleeding and also bruising. Contrasted with ligation and also stripping, endovenous thermal ablation outcomes in less pain and also a much faster return to typical activities, with comparable cosmetic results.

Surgical Treatments


When is surgery necessary?

For the much less than 10 percent of patient who call for surgical treatment, the choices include vein ligation and also stripping, microincision/ambulatory, and also bypass surgery. Below is a short review of each of these techniques. Her doctor deserve to recommend the treatment that is most appropriate for you.

Ligation and stripping often are performed in combination. Vein ligation is a procedure in i m sorry a vascular surgeon cuts and ties off the difficulty veins. Most patients recoup in a few days and can resume their normal activities. Stripping is the surgical removal of bigger veins with two small incisions. Stripping is a an ext extensive procedure and also may require up come 10 days because that recovery. That usually causes bruising for several weeks after surgery.

Microincision/ambulatory is a minimally invasive procedure in which small incisions or needle punctures are made over the veins, and a hook is offered to eliminate the problem veins.

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Vein bypass in the foot is similar to heart bypass surgery, simply in a various location. It requires using a portion of healthy and balanced vein transplanted from elsewhere in your body come reroute blood roughly the vein impacted by CVI. Bypass is offered for treatment of CVI in the upper thigh and only in the most severe cases, once no other treatment is effective.

What room the risk components for chronic venous insufficiency?

If you have risk components for CVI, you are an ext likely than other civilization to construct the disease. The most necessary risk determinants are:

Deep vein thrombosis (DVT)Varicose veins or a family background of varicose veinsObesityPregnancyInactivitySmokingExtended durations of was standing or sittingFemale sexAge over 50