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Chronic Venous Insufficiency

Definition

Chronic venous insufficiency (CVI) is a problem with the veins. Veins bring blood back to the heart. They have valves to keep blood moving in one direction. When the valves don’t close properly, blood can leak back. This can cause a backup of blood in the veins. The legs are a common place for blood to backup. This is because veins must work against gravity.

Venous Insufficiency

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Causes    TOP

Damage to the valves causes problems in the veins. This can be related to inflammation or low blood flow. Damage can happen because of:

  • Increase in blood pressure in the veins
  • Stuctural problems—some may be present from birth
  • Health conditions such as:

For some, the cause may remain unknown.

Risk Factors    TOP

Having DVT makes your chances of CVI higher. Other factors include:

  • Obesity
  • Lack of physical activity
  • Family members with the same problems
  • Smoking
  • Pregnancy
  • Regularly sitting or standing for long periods of time
  • Wearing tight clothing such as very tight girdles or belts

Symptoms    TOP

CVI may cause:

  • Swelling of the legs
  • Pain in the legs, especially after walking:
    • Aching
    • Dullness
    • Tiredness
    • Cramping
  • Red or brown darkening of the skin on the legs
  • Varicose veins
  • Ulcers on legs, especially around the inside of the ankles
  • Scaling skin on legs
  • Hard, leathery skin on legs

Diagnosis    TOP

The doctor will ask about your symptoms and health history. You may have:

  • A physical exam
  • Imaging tests such as:

Treatment    TOP

The goal of care is to maintain blood flow and prevent it from pooling in the veins. It may involve:

Improving Blood Flow

Your doctor may have you wear compression stockings. They squeeze veins in the legs. This helps keep the blood from pooling. You may need to keep your legs raised above your heart during rest or sleep.

Therapeutic massage of the lower legs can reduce discomfort and drain fluid buildup.

Movement

Walking and specific exercises for your legs and feet may help. Don’t sit or stand for long periods of time.

Skin Care    TOP

Mineral bath therapy may help to improve skin redness. Bandages or antibiotic cream can prevent skin infection. Wearing compression stockings may also promote healing.

Sclerotherapy or Ablation    TOP

Sclerotherapy involves injecting a caustic material into the affected veins. Scar tissue fills the veins. The blood is rerouted through veins that are working properly.

With ablation, a tiny electrode is inserted into the affected vein. Electricity scars the vein and blocks it off.

Over time, the body will resorb the vein that isn’t working (for both).

Surgery    TOP

If other care methods fail, surgery may be needed. The type of surgery will depend on the cause and test results. Options include:

  • Valve repair.
  • Vein stripping to remove the faulty vein.
  • Bypass surgery—A new length of artificial vein is connected to two areas of the malfunctioning vein. This allows the blood flow to bypass the area that is not working.

Prevention    TOP

To help lower your chances of CVI:

  • Maintain a healthy weight.
  • Exercise regularly.
  • If you smoke, talk to your doctor about how to quit.
  • Avoid standing or sitting for long periods of time.
  • Avoid wearing tight clothing such as girdles or belts.

RESOURCES:

National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov
Society for Vascular Surgery
https://vascular.org

CANADIAN RESOURCES:

Canadian Society for Vascular Surgery
https://vascular.ca

References:

Chronic venous insufficiency. Society for Vascular Surgery website. Available at: https://vascular.org/patient-resources/vascular-conditions/chronic-venous-insufficiency. Accessed July 11, 2018.
Chronic venous insufficiency and postphlebitic syndrome. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/chronic-venous-insufficiency-and-postphlebitic-syndrome. Updated March 2018. Accessed July 11, 2018.
Venous insufficiency. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated August 18, 2016. Accessed July 11, 2018.
2/17/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115837/Venous-ulcer: O'Meara S, Cullum N, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2009;(1):CD000265.
3/30/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.... dos Santos Crisóstomo RS, Costo DS, et al. Influence of manual lymphatic drainage on health-related quality of life and symptoms of chronic venous insufficiency: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(2):283-291.
Last reviewed June 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 7/11/2018

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