Chronic venous insufficiency or CVI is a medical condition where the veins cannot
pump enough blood back to the heart. The most common cause of CVI is superficial
venous reflux which is a treatable condition. As functional venous valves
are required to provide for efficient blood return from the lower extremities,
this condition typically affects the legs. If the impaired vein function
causes significant symptoms, such as edema and ulceration, it is referred to
as chronic venous disease. CVI includes varicose veins and superficial venous
reflux It is sometimes called chronic peripheral venous insufficiency and
should not be confused with post-thrombotic syndrome in which the
deep veins have been damaged by previous deep vein thrombosis.
Most people with CVI can be improved with treatments to the superficial
venous system or stenting the deep system. Varicose veins for example can
now be treated by local anaesthetic endovenous surgery.
Men and women are not affected equally since the prevalence is far higher in
women. The Tampere study, which examined the epidemiology of varicose veins in a
large cohort of 3284 men and 3590 women, demonstrated that the prevalence of
varicose veins in men and women was 18% and 42%, respectively. The condition has
been known since ancient times and Hippocrates used bandaging to treat it.
Signs and symptoms Signs and symptoms of CVI in the leg
include the following: Varicose veins
Itching Hyperpigmentation
Phlebetic lymphedema Chronic swelling of the legs and ankles
Venous ulceration CVI in the leg may cause the following:
Venous stasis Ulcers.
Stasis dermatitis, also known as varicose eczema
Contact dermatitis. Patients with venous insufficiency have a disrupted epidermal
barrier, making them more susceptible than the general population to contact
sensitization and subsequent dermatitis. Atrophie blanche. This is an end point
of a variety of conditions, appears as atrophic plaques of ivory white skin
with telangiectasias. It is a late sequelae of lipodermatosclerosis where
the skin has lost its nutrient blood flow.
Lipodermatosclerosis. This is an indurated plaque in the medial
malleolus. Malignancy. Malignant degeneration is a
rare but important complication of venous disease since tumors which
develop in the setting of an ulcer tend to be more aggressive.
Pain. Pain is a feature of venous disease often overlooked and commonly
undertreated. Anxiety.
Depression. Inflammation
Discoloration Skin thickening
Cellulitis Causes
CVI in the leg may be caused by the following:
Blood clots in the deep veins. This is called Deep vein thrombosis, or DVT. CVI
caused by DVT may be described as postthrombotic syndrome
Arteriovenous fistula. Phlebitis
Thrombophilia Obesity
May-Thurner syndrome. This is a rare condition in which blood clots occur in
the iliofemoral vein due to compression of the blood vessels in the leg. The
specific problem is compression of the left common iliac vein by the overlying
right common iliac artery. An alternative explanation has shown
Chronic venous insufficiency as the result of venous valves incompetence
instead and/or obstacles to the flow Management
Surgical treatment of CVI attempts a cure by physically changing the veins
with incompetent valves. Surgical treatments include:
Linton procedures Ligation. Tying off a vein to prevent
blood flow Vein stripping. Removal of the vein.
Surgical repair. Endovenous Laser Ablation
Vein transplant. Subfascial endoscopic perforator
surgery. Tying off the vein with an endoscope.
Valve repair Valve transposition
Hemodynamic surgeries. Treatment of CVI in the leg involves
managing the symptoms instead of effecting a cure. It is sometimes called
conservative treatment. Conservative treatments include:
Manual compression lymphatic massage therapy
Skin lubrication Sequential compression pump
Ankle pump Compression stockings
Blood pressure medicine, Frequent periods of rest elevating the
legs above the heart level Tilting the bed so that the feet are
above the heart. This may be achieved by using a 20 cm bed wedge or sleeping in a
6 degree Trendelenburg position. Obese or pregnant patients might be advised by
their physicians to forgo the tilted bed.
See also Atrophie blanche
Compression stockings Lipodermatosclerosis
Venography Venous stasis
Venous ulcer References
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