What is Chronic Venous Insufficiency (CVI)?
Chronic Venous Insufficiency is the most common disease of the peripheral vascular system. About 10-35% of adults will develop some form of venous insufficiency.
Chronic Venous Insufficiency is the result of impaired blood flow in the veins of the lower extremities due to insufficiency of the valves. Due to the insufficiency of one or more veins, a reflux of the blood is observed in them. This results in the initiation of a series of changes in the legs that can range from the appearance of varicose veins to the most serious manifestation of the deficiency which is the ulcer.
What causes CVI and what are the symptoms?
The main risk factors that can lead to Chronic Venous Insufficiency are:
- History of venous thrombosis
- Family history of chronic venous insufficiency
- Prolonged standing
- Pregnancy
- Lack of exercise
- History of injury
- Obesity
- Smoking
Symptoms you may have include:
- Pain and feeling of heaviness in the legs
- Edema of the lower extremities (swollen feet)
- Brownish discoloration of the skin
- Spider and reticular veins
- Varicose veins
- Ulcers (sores) on the legs
Diagnosis
The diagnosis of chronic venous insufficiency is primarily made by physical examination and a detailed history of the patient. Subsequently, a duplex ultrasound of the veins of the lower extremities is performed to confirm the diagnosis. This is a non-invasive test able detect venous insufficiency with great accuracy.
Depending on the findings of the duplex and the patient’s history as well, the patient may need to undergo an computed or magnetic venography in which the abdominal and pelvic veins are imaged in greater detail.
Treatment
Treatment of chronic venous insufficiency can be conservative or surgical, depending on the severity of the disease and symptoms. Patients with venous insufficiency who present with lower extremity edema or mild varicose veins may initially be managed conservatively with compression stockings, avoidance of prolonged standing, and keeping the legs elevated at rest.
In case of insufficiency of the saphenous vein (great or small) and persistent symptoms, varicose veins or ulcers where conservative treatment was not successful, then ablation of the saphenous vein is indicated. Ablation can be done by:
- Laser
- Radio Frequency (RF)
- Sclerosants
At the same time, it may be necessary to perform stab phlebectomies with “mini” incisions on the skin, or to perform sclerotherapy by injecting special sclerosants into the reticular or varicose veins.
The operation is usually performed under local anesthesia and the patient is discharged home the same day. Ambulation is immediate and recovery is quick.
Traditional surgical saphenectomy (excision of the saphenous vein) is performed mainly in cases where ablation methods cannot be used.
The sclerotherapy method can be performed at the same time as the ablation but also later on as some varicose veins and varicose veins may persist. Using a small needle and a syringe the sclerosant is injected into the veins. Depending on the extent, 2-3 office sessions may be required for sclerotherapy treatment.
In all of the previously described cases, we recommend that the patient wears compression stockings after the procedure for 2-3 weeks.
