Chronic Venous Insufficiency (CVI) is a condition wherein the leg veins are not able to pump enough blood back to the heart. It is caused by congenital absence of or damage to venous valves; venous incompetence from thrombi; and thrombi formation that is primarily caused by venous stasis, hypercoagulability, and endothelial trauma, collectively known as Virchow triad.
There are several risk factors that would predispose an individual to CVI.
- Increasing age is one of the risk factors since the incidence of CVI is directly proportional with age.
- A family history of deep vein thrombosis (DVT) that causes the valvular incompetence which results to backflow and increased venous pressure also predisposes an individual to CVI.
- Sedentary lifestyle, obesity, and prolonged standing increases venous pressure which makes it a risk factor.
- And lastly, there is an increased risk for CVI in individuals who smoke.
People with CVI have varicose veins due to the increased venous pressure on the legs. Complaints of leg discomfort are common primarily due to venous hypertension from prolonged standing. Patients would describe this as a burning sensation, dull ache, or heaviness in the legs. Leg edema is also present due to the damage in the capillary membranes. Skin changes in the legs can also be seen due to capillary proliferation, fat necrosis, and fibrosis of skin and subcutaneous tissues. The skin appears reddish or brown due to hemosiderin deposition. Skin ulcers are often seen due to poor blood flow to the lower extremities.
– Vein ligation is indicated for patients with severe leg pain, skin ulcers due to poor venous blood flow, and thickening and hardening of the skin in the affected leg.
– Sclerotherapy is also used to manage CVI; where the physician injects a strong chemical to the affected veins, scarring the abnormal vein, which results to inability of the veins to fill with blood. The blood will then be returned back to the heart using other veins.
– Ablation can also be done where a catheter is inserted into the varicose vein, heating its walls and destroying the vein tissue.
However, for mild cases of CVI, the usage of compression stockings is recommended. These are elastic stockings used to squeeze veins, stopping the backflow of excess blood. These are also used to manage skin sores. For patients with CVI, wearing of compression stockings is for life. Prolonged sitting or standing is avoided. Movement or activity is important to improve the circulation. Wound care is also important in cases of skin breakdown and infections.