Chronic venous insufficiency (CVI) affects nearly 40% of adults in the United States, a condition where the veins in the legs fail to function correctly, hindering blood flow back to the heart. Dr. Miguel F. Manzur, a vascular surgeon with the USC Cardiac and Vascular Institute, part of Keck Medicine of USC, provides crucial insights into CVI, including its symptoms, risk factors, diagnosis, and treatment options.
What is Chronic Venous Insufficiency?
CVI occurs when the valves in the leg veins deteriorate over time, preventing blood from flowing upward toward the heart. As a result, blood accumulates in the lower legs, leading to various symptoms. Common indicators include leg swelling, a sensation of heaviness or fatigue in the legs, varicose veins, skin discoloration, and in some cases, ulceration. Swelling is often the principal symptom reported by affected individuals.
Identifying Risk Factors
Several factors increase the likelihood of developing CVI. Age plays a significant role, as the risk escalates for individuals over the age of 50. Gender is another critical factor; women are more susceptible to CVI, particularly due to changes during pregnancy that elevate blood volume and alter hormonal levels.
Genetics also contribute significantly to the risk. If a family member such as a mother or aunt has experienced venous issues, the likelihood of similar problems increases. Other risk factors include obesity, a sedentary lifestyle, and prolonged periods of sitting or standing, which can disrupt normal blood flow. Individuals with a history of deep vein thrombosis are particularly vulnerable, as this condition involves blood clots forming in deep veins, usually in the legs or pelvis.
Diagnosis of Chronic Venous Insufficiency
Diagnosing CVI requires a thorough examination to rule out other potential causes of leg swelling. Conditions such as congestive heart failure or kidney and liver diseases can also lead to similar symptoms. Doctors conduct physical exams, looking for signs like spider veins or varicose veins, and may perform a venous reflux ultrasound. This noninvasive test evaluates how well the vein valves function, identifying any backward blood flow that indicates CVI.
Treatment Options for Chronic Venous Insufficiency
Treatment approaches for CVI vary based on symptom severity. For some, the condition may be more of an inconvenience, characterized by heavy or tired legs. In such cases, lifestyle modifications are often recommended. Increasing physical activity, such as walking, can help as leg muscles act to pump blood back toward the heart. Patients are also advised to avoid prolonged sitting or standing, maintain a healthy weight, and elevate their legs to alleviate swelling.
Compression stockings are another first-line treatment, providing support to the veins. For patients with untreated CVI or those who have experienced deep vein thrombosis, more severe issues may arise, such as skin discoloration known as lipodermatosclerosis, which can lead to ulcers. In such instances, proper wound care is essential to prevent infections.
If conservative measures fail to relieve symptoms, doctors may consider more invasive options. Venous ablation can be performed to remove damaged veins and is typically a quick procedure that can be done in a doctor’s office, lasting about 20–30 minutes. Other minimally invasive treatments include stenting and phlebectomy.
Long-Term Management and Traveling with CVI
Although treatments can be effective and provide long-lasting relief, CVI is a chronic condition that may recur. For individuals with extensive disease, ongoing communication with a vein specialist is crucial for monitoring and potential further treatment.
Traveling can pose additional challenges for those with CVI, as extended periods of sitting can exacerbate swelling and discomfort. Dr. Manzur advises patients to wear compression socks during long flights or car rides. He recommends elevating legs when possible and taking breaks to walk around every hour to encourage blood flow. While seated, calf pumps can help stimulate circulation.
Understanding chronic venous insufficiency is vital for effective management and improving quality of life for those affected. With the right approach to treatment and prevention, individuals can mitigate symptoms and maintain better leg health.
