Chronic venous insufficiency (CVI) is a common yet often misunderstood condition affecting millions across the globe. Although it can cause discomfort and impact daily life, gaining a better understanding of CVI can help individuals manage the condition and improve their quality of life.
This article will explore what CVI is, its causes, symptoms, and risk factors, as well as potential complications. We’ll also discuss how it is diagnosed and the various treatment options available, from lifestyle changes to medical interventions.
What Is Chronic Venous Insufficiency?
Chronic venous insufficiency occurs when the veins in your legs fail to return blood back to your heart effectively. Veins contain valves that open and close to ensure blood flows in one direction, but when these valves become damaged or weakened, blood can pool in the veins of the legs. This pooling leads to increased pressure, swelling, and a range of other symptoms over time.
CVI is considered “chronic” because it develops gradually and may persist without proper treatment. While the condition itself is rarely life-threatening, the symptoms can significantly impact daily activities and, in severe cases, lead to complications.
Causes of CVI
CVI typically arises from issues that damage or put strain on the veins. Some of the most common causes include:
- Venous valve dysfunction: The small valves inside your veins may become weak or damaged from aging or other factors, causing blood to flow backward instead of upward toward the heart.
- Deep vein thrombosis (DVT): A history of blood clots in the deep veins can damage valves and disrupt normal blood flow.
- Prolonged sitting or standing: Staying in one position for extended periods can increase pressure in the leg veins.
- Obesity: Excess weight can place additional strain on the veins, contributing to valve damage.
- Pregnancy: Changes in hormone levels and increased blood volume during pregnancy can affect vein function, particularly in the legs.
Symptoms of CVI
The symptoms of CVI can vary widely but often worsen over time if left untreated. Common signs include:
- Swelling in the lower legs, particularly after long periods of standing or sitting
- A feeling of heaviness or aching in the legs
- Leg cramps or muscle tightness
- Itchy or irritated skin on the lower legs
- Varicose veins (twisted, bulging veins visible under the skin)
- Discoloration or thickening of the skin, especially around the ankles
- Ulcers or open sores on the legs, which may be slow to heal
These symptoms are often more noticeable in the afternoon or evening and may improve with rest or elevation of the legs.
Who Is at Risk?
Several factors can increase your risk of developing CVI:
- Age: The likelihood of valve dysfunction increases as we age.
- Gender: Women are more prone to CVI, particularly due to hormonal changes during pregnancy, menopause, or while using hormonal contraceptives.
- Family history: A genetic tendency to develop weak veins or valve issues may run in families.
- Lifestyle factors: Long periods of inactivity or repetitive motion that involves sitting and standing can worsen vein health.
- Other medical conditions: A history of blood clots or varicose veins may make you more vulnerable to CVI.
Potential Complications
If untreated, CVI can lead to more severe complications, such as:
- Venous ulcers: Open sores, typically on the lower legs, which can develop due to prolonged pressure and poor circulation.
- Bleeding: Fragile varicose veins near the skin’s surface may tear and bleed if injured.
- Deep vein thrombosis: Prolonged blood pooling in the veins increases the risk of developing blood clots.
- Venous stasis dermatitis: A skin condition caused by chronic inflammation and fluid leakage in the lower limbs.
Addressing CVI early can help prevent these complications and improve long-term outcomes.
Diagnosing CVI
A healthcare provider can diagnose CVI through a combination of:
- Physical exam: The doctor examines your legs for swelling, discoloration, and visible veins.
- Medical history: Your symptoms, health history, and lifestyle will be reviewed to identify risk factors or underlying issues.
- Ultrasound: A duplex ultrasound helps visualize blood flow in the veins and detect valve dysfunction or blood clots.
These diagnostic steps ensure that other conditions, such as peripheral arterial disease, are ruled out.
Treatment Options
The good news is that a wide range of effective treatments for CVI exists, from simple lifestyle changes to advanced medical procedures. Here are the main approaches:
1. Lifestyle Changes
Adjusting daily habits can go a long way in managing mild to moderate CVI symptoms. Key steps include:
- Exercising regularly to improve circulation, especially walking or cycling.
- Elevating your legs above your heart for 15–30 minutes several times a day to reduce swelling.
- Wearing compression stockings to improve blood flow and prevent pooling.
- Avoiding long periods of standing or sitting and taking breaks to stretch and move.
2. Medications
While medications cannot reverse CVI, they can help reduce symptoms. Doctors may prescribe:
- Diuretics to reduce fluid retention and swelling.
- Blood thinners (anticoagulants) to lower the risk of blood clots if needed.
3. Minimally Invasive Procedures
If lifestyle changes and medications aren’t enough, minimally invasive treatments can address vein dysfunction directly:
- Sclerotherapy: A solution is injected into small or medium-sized varicose veins, causing them to close and eventually fade.
- Endovenous laser therapy (EVLT) or radiofrequency ablation (RFA): Heat energy is used to seal off larger problem veins.
- Microphlebectomy: Small incisions are made to remove varicose veins near the surface.
4. Surgery
For severe cases, surgical options like vein stripping or using bypass grafts may be considered. While more invasive, surgery is typically reserved for cases where other treatments fail.
Managing CVI for the Long Term
Living with CVI often involves a combination of medical treatment and ongoing self-care. Staying active, maintaining a healthy weight, and following your doctor’s recommendations can help manage symptoms and prevent complications. Regular check-ups are also essential to monitor your vein health.
(Featured image via Mandel Ngan/AFP/Getty Images)
