Chronic Venous Insufficiency (CVI) commonly affects lower limbs with a prevalence ranging between 25–40% in women and men, respectively.
CVI is a very common problem, with varicose veins affecting more than 25 million adults in the United States and more than 6 million with more advanced venous disease.
The more serious consequences of CVI, such as venous ulcers, have an estimated prevalence of ≈0.3%, although active or healed ulcers are seen in ≈1.0% of the adult population. It has been estimated that approximately 2.5 million people experience CVI in the United States, and of those ≈20% develop venous ulcers.
What causes CVI?
The venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis.
How is CVI diagnosed?
To diagnose CVI, your doctor will perform a complete medical history and physical exam. During the physical exam, the doctor will carefully examine your legs.A test called a vascular or duplex ultrasound may be used to examine the blood circulation in your legs. During the vascular ultrasound, a transducer (small hand-held device) is placed on the skin over the vein to be examined. The transducer emits sound waves that bounce off the vein. These sound waves are recorded, and an image of the vessel is created and displayed on a monitor.
Initial Presentation:
Gaiter distribution, from ankle to mid or upper calf
Hemosiderin staining, brawning or rusty reddening of skin- hemoglobin leaking from venous vessels as fluid is backed up
Taut, leathery banding and contraction
Underlying tissue fibrosis
Achiness, pain
Edema from ankle to calf
Superficial vein failure: slow process that takes many decades to show
Valvular weakness
Pressure increase from 30 mmhg to 100 mmhg
Ambulation pressure goes up 8 mmhg
Perforator stress and pooling
Ischemia leading to wounds or deoxygenated tissue and development of wounds
Delayed edema formation
Deep vein failure:
Adherent clot obstruction, valve destruction, deep vein hypertension
Superficial vein hypertension
Position can increase pressure
Ambulation increases pressure
Management:
Avoid long periods of standing or sitting: If you must take a long trip and will be sitting for a long time, flex and extend your legs, feet, and ankles about 10 times every 30 minutes to keep the blood flowing in the leg veins. If you need to stand for long periods of time, take frequent breaks to sit down and elevate your feet.
Exercise regularly. Walking is especially beneficial.
Lose weight if you are overweight.
Wear compression stockings.
Take antibiotics as needed to treat skin infections.
Practice good skin hygiene
PREVENTION: COMPRESSION GARMENTS
Compression garments and their classes below:
Schedule a visit now and we can assess your CVI needs and obtain a correctly fitted compression garment to assist with the symptoms of this disease. Manual Lymphatic Drainage massage is also indicated to help increase fluid uptake and movement via the lymphatic vessels. This can help with some of the discomfort and extra swelling you may get from venous and lymphatic conditions.
Raffetto J, Eberhardt RT. Chronic venous disorders: general considerations. In: , Cronenwett JL, Johnston KW, eds. Rutheford’s Textbook of Vascular Surgery, 7th Edition. Philadelphia, PA: Saunders-Elsevier; 2010:831–843.
Fowkes FG, Evans CJ, Lee AJ. Prevalence and risk factors for chronic venous insufficiency.Angiology. 2001; 52:S5–S15.
Ruckley CV, Evans CJ, Allan PL, Lee AJ, Fowkes FG. Chronic venous insufficiency: clinical and duplex correlations: the Edinburgh Vein Study of venous disorders in the general population.J Vasc Surg. 2002; 36:520–525.