Chronic vascular insufficiency (CVI), also known as chronic venous disease or chronic venous stasis, is a common condition, usually affecting the legs, which leads to blood pooling and associated complications such as varicose veins, phlebitis, pain, swelling and ulcers. Its basic cause is the malfunction of the valves, which ordinarily ensure blood flows in one direction only– upwards, or back towards the heart. One or more of the following are predisposing factors for CVI:
- -Advancing age
- -Female gender (women are more at risk due to the effects of progesterone)
- -Genetic inheritance (vein valve defects, or hypercoagulability, which can damage the valves)
- -Pregnancy (by pressing on the pelvic veins. The more pregnancies the worse)
- -Height (taller people are more likely to develop CVI)
- -Previous DVT (Deep Venous Thrombosis, by increasing pressure within the veins)
- -Obesity (by pressure of the belly fat pads on the groin and pelvic veins)
- -Prolonged periods of sitting or standing
Although CVI can occasionally affect the arms, it is far more common in the legs owing to the pull of gravity on the length or height of the vein from the heart. CVI is not usually limb-threatening but professional diagnosis and treatment is recommended because of annoying dull ache, cramps, burning and later, severe swelling, skin discoloration and hardening (lipodermatosclerosis) and ulceration.
What are the Common Symptoms of CVI?
It is best to treat CVI earlier rather than later, before the changes become irreversible. As well as being unsightly, enlarged veins can become inflamed (phlebitis) and can give rise to thrombosis (blood clots), which can cause further damage to veins and even dislodge leading to pulmonary embolism (PE).
Symptoms associated with CVI include:
- -Pain, often a dull ache, that worsens with standing and is relieved on raising the leg
- -Pain in the calves and feet after getting into bed at night
- -Swelling and reddening of the leg, especially around the ankles
- -Brown discoloration of the skin around the ankles which can also become thick and hard (lipodermatosclerosis)
- -Varicose veins which may become inflamed with or without clots (phlebitis)
- -Itching, tingling or burning skin of the legs
- -Tightening around the calves by swelling and, more seriously, by the skin becoming leathery
- -Ulcers or open sores on the legs, especially on the inside of the ankles (which may heal slowly or not at all)
How is CVI Diagnosed?
A medical professional takes a full medical history, asks the patient about their symptoms, other conditions, pregnancies, social history, family history etc., and then performs a complete physical examination including all systems. A duplex ultrasound examination would then be undertaken to evaluate the venous system (and if indicated arterial as well). This examination comprises both Doppler and B-modes (black-and-white 2D mode) ultrasonography. The Doppler examination measures the velocities and shows the direction of blood flow, while the B-mode produces a 2D image of the vessels, their walls and any clots.
If the results of the ultrasound are unclear, a venogram may be suggested whereby the vein is injected with a contrast dye before the limb undergoes fluoroscopy (a special type of x-ray). Venograms are not recommended for pregnant women, diabetic patients or those with kidney problems because of the amount of contrast used. There are also minor risks associated with radiation exposure, allergic reaction to the dye used and infection of the injection site.
Treatments for CVI
Initial treatment for CVI, particularly if symptoms are mild may involve wearing a compression stocking, which most insurance companies mandate prior to approval. Compression does alleviate symptoms and often retard the progress of disease. Compression stockings are especially designed garments, which are designed to exert maximal compression at the ankle and least at the top, hence assist the flow of blood towards the heart.
Lifestyle changes such as weight loss and exercise, particularly of the legs, are also recommended and any wounds will need to be looked after carefully, but wounds resulting from stasis and CVI will never heal satisfactorily until the core reason is addressed. Where there is pain or symptoms causing significant problems and interfere with work or simply with well-being, there are a range of treatment options available. These include sclerotherapy, the injection of an approved substance to close the vein, allowing the body physiology to heal it closed; and minimally-invasive laser or radio frequency ablation of the offending vein, which uses heat to close off and later heal. In both cases, the remnants of the vein will eventually shrivel up and her absorbed naturally and disappears to a strand of fibrous tissue. Surgical procedures include stripping the vein (now obsolete in our practice); microphlebectomy, whereby the vein is removed through tiny incisions much like ice-fishing; and venous bypass, involving a graft to divert blood around the affected area, which is extremely rare. Where deep veins have become blocked, angioplasty may be the recommended course of action with or without stents. Stenting involves the inflation of a balloon inside the vein followed by the insertion of a mesh tube known as a stent, which in turn is ironed out with a balloon.
There is no one size fits all treatment for varicose veins or other symptoms of CVI. For advice and a free compression stocking please book a consult with the Spring of Youth Medical Group on (228) 875-0885 or visit www.springofyouthmedical.com