Chronic Venous Insufficiency (CVI)
Chronic venous insufficiency is caused by
higher-than-normal blood pressure within the leg veins.
This may be due to blood clots or phlebitis (swelling
and inflammation of the veins). Blood clots in the legs
(called deep vein thrombosis ) can damage the valves in
the veins. When people get chronic venous insufficiency
after a blood clot, it may be referred to as
post-thrombotic syndrome. When it occurs after
phlebitis, it may be referred to as postphlebitic
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Chronic venous insufficiency can be caused by blood
clots, which can damage the valves in the veins.
Other causes of chronic venous insufficiency include:
Congenital (inherited at birth) absence
or weakness of valves in the leg veins
Increased venous pressure in the legs
for any reason
A risk factor is something that increases your chances
of getting a disease or condition.
Risk factors for chronic venous insufficiency include:
Increased age (50 and over)
Family members with deep vein thrombosis
or varicose veins
Regularly sitting or standing for long
periods of time
Wearing restrictive clothing such as
very tight girdles or belts
When blood pools in the legs, it puts pressure on the
veins. Sometimes the blood leaks out into the tissues,
discoloring and damaging the skin, and even causing skin
ulcers. Symptoms of chronic venous insufficiency can
Swelling of the legs
Pain in the legs (especially after
Darkening of the skin on the legs
(reddish or brown)
Ulcers on legs, especially around the
inside of the ankles
Scaling skin on legs
Hard, leathery skin on legs
The doctor will ask about your symptoms and medical
history and perform a physical exam. If the diagnosis is
not clear from the exam or you are considering surgery,
you may also have the following tests:
Duplex scanning (venous ultrasound/
Doppler ) — An ultrasound is a test that
uses sound waves to examine the inside
of the body. In this case, the blood
flow in the veins in your legs is
evaluated and the presence of a clot can
Venogram (X-ray of the veins) — An X-ray
is a test that uses radiation to take a
picture of structures inside the body.
In this case, dye will be injected into
a vein in your foot, and several X-rays
will be taken.
Once the valves have been damaged, they usually cannot
be repaired. Treatment is ongoing and is aimed at
maintaining blood flow and preventing pooling of blood.
Treatment involves the following:
Elastic support — Your doctor will
prescribe special elastic stockings that
squeeze the veins in the legs and keep
the blood from pooling.
Elevation — Raise your feet and legs
above the level of your heart while
resting or sleeping. Your doctor may ask
you to do this several times a day.
Exercise — Your doctor may encourage you
to walk and to do specific exercises for
your legs and feet.
Mineral bath therapy (balneotherapy) —
This treatment may help to improve
symptoms, even in advanced cases of
chronic venous insufficiency.
Movement — Avoid long periods of sitting
or standing. If you go on an extended
trip, get up and walk or flex your leg
muscles every 30 minutes or so.
Skin care — If you have a skin ulcer,
your doctor may use bandages (Unna
boots) and/or apply an antibiotic cream
to help prevent infection. Wearing
compression stockings may also promote
Sclerotherapy — This treatment involves
injection of a caustic material into the
malfunctioning veins. Scar tissue fills
the veins, and the blood is rerouted
through other, more functional veins.
Over time, your body will resorb the
Ablation — A tiny electrode is inserted
into the malfunctioning vein, and
electricity/heat scars the vein,
blocking it off. As with, sclerotherapy,
your body will resorb the nonfunctional
vein over time.
Surgery — Surgery is reserved for the
few cases where discomfort or ulcers do
not respond to conservative treatment.
The type of surgery recommended will
depend on your particular reason for
having this condition, and the results
of testing. Some possibilities include:
Vein stripping —This
involves the removal of
the faulty vein.
Bypass surgery — A new
length of artificial
vein (a graft) is
connected to two areas
of the malfunctioning
vein, in order to allow
the blood flow to bypass
the area that is not
To help prevent chronic venous insufficiency, take steps
to decrease your risk factors. These include:
Maintain a healthful weight.
If you smoke, quit.
Avoid prolonged standing or sitting.
Avoid wearing restrictive clothing such
as very tight girdles or belts.
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/
Vascular Disease Foundation http://www.vdf.org/