Introduction - What is chronic venous insufficiency?Arteries bring oxygen-rich blood from your heart to the rest of your body and veins return oxygen-poor blood back to your heart. When your leg veins cannot pump enough blood back to your heart, you have chronic venous insufficiency (CVI). CVI is also sometimes called chronic venous disease, or CVD. You have three kinds of veins: superficial veins, which lie close to the skin, deep veins, which lie in groups of muscles, and perforating veins, which connect the superficial to the deep veins. Deep veins lead to the vena cava, your body's largest vein, which runs directly to your heart.
When you are in the upright position, the blood in your leg veins must go against gravity to return to your heart. To accomplish this, your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. One-way flaps, called valves, in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump.
When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and increase the venous blood pressure. Deep veins and perforating veins are usually able to withstand short periods of increased pressures. However, sitting or standing for a long time can stretch vein walls because they are flexible. Over time, in susceptible individuals, this can weaken the walls of the veins and damage the vein valves, causing CVI.
What are the symptoms?If you have CVI, your ankles may swell and your calves may feel tight. Your legs may also feel heavy, tired, restless, or achy. You may feel pain while walking or shortly after stopping.
CVI may be associated with varicose veins. Varicose veins are swollen veins that you can see through the skin. They often look blue, bulging, and twisted. Large varicose veins can lead to skin changes like rashes, redness, and sores.
CVI can also cause problems with leg swelling because of the pressure of the blood pooling in the veins. Your lymphatic system may also produce fluid, called lymph, to compensate for CVI. Your leg tissues may then absorb some of this fluid, which can increase the tendency for your legs to swell. In severe cases, CVI and the leg swelling can cause ulcers to form on the lower parts of the leg.
Summary of common symptoms:
What causes CVI?In healthy veins, there is continuous flow of blood from the limbs back toward the heart. There are valves within the veins of the legs that prevent the backflow of blood. Venous insufficiency occurs when forward flow through the veins is obstructed, as in the case of a blood clot, or if there is backward leakage of blood flow through damaged valves. In many cases of venous insufficiency, patients have both obstruction of forward flow and backward leakage of the veins. Over the long-term, blood pressure that is higher than normal inside your leg veins causes CVI. This can lead to damage to the valves, which can further worsen the problem. In some instances, the valves that prevent blood from flowing “backwards,” can be congenitally defective.
The most common causes of venous insufficiency are previous cases of blood clots and varicose veins. In some cases, weakness of the leg muscles that help squeeze blood forward may also contribute to venous insufficiency.
Deep Vein Thrombosis (DVT) occurs when a blood clot (properly called a thrombus) blocks blood from flowing toward the heart, out of a deep or perforating vein. The blood trying to pass through the blocked veins can increase the blood pressure in the vein, which, in turn, overloads your valves. Vein valves that do not work properly are called incompetent because they stretch and no longer work efficiently, and incompetent valves contribute to CVI. DVT is a potentially serious condition that causes leg swelling and requires immediate medical attention because sometimes the blood clots in the veins can break off and travel to the lungs. This condition is called a pulmonary embolus.
Phlebitis occurs when a superficial or deep vein becomes swollen and inflamed. This inflammation causes a blood clot to form, which can also lead to DVT.
Factors that can increase your risk for CVI include:
- a family history of varicose veins
- being overweight
- being pregnant
- not exercising enough
- standing or sitting for long periods of time
- Although CVI can affect anyone, your age and sex can also be factors that may increase your tendency to develop CVI; women older than 50 most often get CVI.
How is venous insufficiency treated?There are many treatment options for venous insufficiency, depending upon the condition that is causing it. Our primary focus at Edema Rehab is to reduce the swelling, facilitate the healing of any wounds and progress into over-the-counter or prescription-wear compression stockings. These special elastic stockings apply pressure at the ankle and lower leg and improve venous blood flow and reduce leg swelling.
Compression stockings are available in a range of prescription strengths and in different lengths (such as knee-high or thigh-high stockings). Your therapist will determine the type of compression stocking that is most appropriate for your care.
To further help with the leg swelling caused by venous insufficiency, your therapist may also tell you to keep your legs elevated above your heart when you are lying down. He or she may also suggest that you get more exercise; for example, walking can improve your circulation. Weight loss can also be very helpful for treatment of venous insufficiency for patients who are overweight.
More serious cases of CVI may be treated with injections, called sclerotherapy, or with surgical procedures. Fewer than 10 percent of people with CVI require surgery to correct the problem. Surgical treatments include ablation, vein stripping, bypass surgery, valve repair, and angioplasty or stenting of a vein. Your Vascular Surgeon will help you decide on the most appropriate option for your care. Often, Edema Rehab will be instrumental in ensuring that your affected limb is in the best possible shape prior to any surgery and we will work closely with your physician to promote a successful outcome.
PreventionPrevention of venous insufficiency is important, especially if there is a strong family history. Strategies for prevention of blood clots can help you avoid chronic venous insufficiency. Prevention methods for each patient may be different; therefore, you should seek advice from a medical provider to design a personal program for each situation.
Generally, you can help prevent venous insufficiency with the following steps:
- Maintain a healthy body weight; lose weight if you are overweight.
- Exercise regularly.
- If you smoke, try to quit. Smoking is harmful to the circulation.
- Protect your legs from injury.
- Do not stand or sit in one place or position for very long; get up and move.