This blood condition is the result of weak blood flow. How it's diagnosed, how to treat it
Chronic venous insufficiency (CVI) is when the valves in the leg veins don’t work right and inappropriately allow blood to flow backward, back into the legs/feet from the effects of gravity. This is often due to a weakness in the vein walls causing them to dilate, which then causes the vein’s valves to fail.
Failed valves can cause a "backup" of blood in the legs, compromising this blood returning to the heart and possibly increasing the pressure in these blood vessels. This increased pressure can cause tiny leg blood vessels to burst, even with minimal trauma (for example, sometimes even from aggressive scratching). This may cause tissue damage, and even lead to leg ulcers.
What happens in patients who have chronic venous insufficiency?
CVI can occur in the veins close to the skin surface (superficial veins), the veins deeper in the legs or the bridging (perforating) veins between these. Extra blood pooling in the legs can lead to leg pain, swelling, cramping/charley horse, skin discoloration or change in skin texture (e.g., "leathery" skin development), varicose veins (affecting up to a third of adults) and can lead to skin breakdown (sometimes even causing leg ulcers).
CVI is common, affecting about 1 in 50 adults over age 50. It's more common in women than men.
Who can develop chronic venous insufficiency?
Risk factors for developing CVI include being overweight, family history, a history of blood clots (up to half of those who have had a blood clot in a leg vein develop CVI within two years) or past injury to the leg(s). It's also more common in people with a history of high blood pressure, those who do not exercise regularly, smokers and those with certain other risk factors.
CVI is suspected based on the history and physical exam. An ultrasound to check the leg veins may be done to confirm the diagnosis. In some cases, an MRI may be indicated to evaluate for other conditions exacerbating the CVI.
The severity of CVI is sometimes "staged" to categorize its severity:
Stage 0: No or very mild symptoms (such as achy or tired legs)
Stage 1: Visible blood vessel changes (such as development of spider veins)
Stage 2: Varicose veins at least 3 millimeters wide
Stage 3: Leg swelling/edema
Stage 4: Skin texture or color changes
Stage 5: Healed skin ulcers
Stage 6: Active skin ulcers
How to treat CVI
The goals of CVI treatment are to improve the blood flow through the leg veins, minimize symptoms and to prevent/alleviate complications such as leg ulcers. Treatment for CVI should be personalized for the individual patient based on the severity of their symptoms, their preferences and the severity of their condition.
If skin ulcers or other complications occur, these will need to be treated (with appropriate wound care, and with antibiotics or other medications as needed), and can sometimes have difficulty healing because of the compromised blood supply. If a blood clot is thought to have been a cause of the CVI, anticoagulant medications may be indicated. Otherwise, medical treatment is not usually effective.
Noninvasive treatments to improve blood flow may include elevating the legs when possible (including while sleeping, possibly by putting something under the foot of the mattress), exercising more and/or wearing compression stockings.
Some minimally invasive treatments may be recommended, including radio frequency or laser vein ablation (to close off the poorly functioning veins, forcing blood to flow through better-functioning veins) or sclerotherapy (sometimes used in more severe cases, in which a chemical is injected into the poorly functioning veins to close them off). Some patients may require more invasive surgery such as vein stripping (this is when the poorly functioning veins are tied off or removed), surgery to bypass the poorly functioning veins (where the blood flow is rerouted, usually only required for very severe cases) and/or other interventions.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
This article originally appeared on MetroWest Daily News: Chronic venous insufficiency: What it is, how to treat it
