Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is a condition affecting the veins, which return blood from the body to the heart. CVI usually occurs in the legs and develops when valves in leg veins don’t work properly. As a result, blood flows backward and pools in the legs. Also called post-thrombotic syndrome, CVI is a condition that often develops after a blood clot known as a deep vein thrombosis.

CVI is a long-term condition that worsens over time. Proper treatment can successfully manage it, though, especially with an early diagnosis. Otherwise, CVI can lead to varicose veins and venous ulcers (skin sores) on the lower legs.

Leg veins send blood up to the heart with the help of contractions in your leg muscles. Valves inside the veins open to send blood toward the heart and close to prevent it from flowing back down the legs. With CVI, weak or damaged valves allow blood to back up in the veins.

Deep vein thrombosis (DVT), or blood clots in leg veins, can damage valves and lead to CVI. When CVI results from these clots, it’s known as post-thrombotic syndrome.

Other factors that increase your risk of CVI include:

• Congenital (present since birth) valve defects in veins
• Damage to leg vein valves, including from previous blood clots, surgery or injury
• Family history of CVI, blood clots or deep vein thrombosis (DVT)
• Work or activities that result in minimal movement, such as standing still or sitting for long periods
• Obesity or excess weight
• Pregnancy
• Smoking

Signs and symptoms of CVI can resemble those of other health conditions. Symptoms that you may experience include:

• Dull aching, cramping or heaviness in legs
• Feeling of discomfort and an urge to move your legs (restless legs syndrome)
• Itching, burning or tingling in the legs
• Pain that improves when elevating your legs
• Pain that worsens when standing

Signs that signal CVI to doctors also include:

• Brown-colored skin, especially near your ankles
• Leg swelling
• Red, swollen, crusted or weepy skin (stasis dermatitis)
• Skin that becomes irritated or cracks if you scratch it
• Thick, hard skin on the legs and ankles (lipodermatosclerosis)
• Varicose veins
• Wounds or ulcers that heal slowly on your legs or ankles

Our vascular team usually diagnoses CVI with a physical exam, looking for common signs such as swelling or skin changes. We also ask you about your symptoms and your personal and family health history.

Certified vascular technologists in our nationally accredited vascular testing labs have specialized training and experience with scans we might need for diagnosis. We typically order imaging to assess blood flow and look for blocked veins. Imaging you may need includes:

• Ultrasound: Sound waves create pictures inside the body to look for blood clots or malfunctioning valves in veins.
• Doppler ultrasound: Specialized ultrasound measures the movement of substances inside the body, such as blood flow.
• Duplex ultrasound: Traditional ultrasound combined with Doppler ultrasound examines blood flow in the legs and checks for clots or valve problems.
• Computed tomography (CT): 3D X-ray equipment produces detailed images inside the body to rule out possible causes.
• Magnetic resonance imaging (MRI): A large magnet and radio waves produce cross-sectional images inside the body to further rule out possible causes.

Our team has expertise in the full range of CVI treatments, including medications, injections and minimally invasive procedures. Our vascular medicine specialists and vascular surgeons work closely with you to decide on the right treatment, based on your specific health needs.

Recommendations for healthy lifestyle habits

Small lifestyle changes can relieve your symptoms and help prevent complications such as skin ulcers. Our vascular medicine specialists have years of experience helping people develop realistic goals to:

• Eat a nutritious, healthy diet to help lose weight and prevent swelling from water retention
• Get moderate exercise, such as walking, to help lose weight and maintain good circulation in the legs
• Maintain a healthy weight

Self-care for CVI

You can take steps on your own to improve the way you feel. We recommend:

• Avoiding sitting or standing in one position for too long by changing your position about every hour
• Wearing compression stockings to relieve swelling and keep blood moving to the heart
• Wearing low-heeled shoes to help tone your calf muscles for improved blood flow to the heart
• Elevating your legs above your heart three to four times per day for 15 minutes each time
• Practicing good skin hygiene, taking care of wounds and moisturizing dry, cracked skin on your legs

Medications and injections for CVI

Our vascular medicine specialists begin CVI treatment with noninvasive therapies such as medications and injections.

You may need one treatment, or a combination:

• Antibiotics: These medications help heal skin infections or ulcers due to CVI.
• Anticoagulants (blood thinners): These medications help prevent blood clots, a risk If you have post-thrombotic syndrome. Heparin, warfarin (Coumadin®) and Xa inhibitors are common blood thinners.
• Vein sealing: Using the VenaSeal™ system, we inject special medical glue to close the problematic vein. Blood continues to flow through other nearby veins, relieving symptoms.
• Sclerotherapy: Your vascular medicine specialist injects liquid or foam chemicals into the affected veins, causing them to close. Blood flows to other veins and returns to the heart. Sclerotherapy is an outpatient procedure done in our offices, so you can return to work the same day.

Minimally invasive CVI treatment

If you are experiencing more severe symptoms, our vascular surgeons offer the latest minimally invasive treatments. Your care team has extensive expertise with these outpatient procedures, developed from helping thousands of people. We use safe, effective treatments with little or no downtime.

Minimally invasive procedures close off the affected veins without disrupting blood circulation, because blood goes to other, healthy veins. Many procedures use an endovascular approach, meaning the work takes place inside the veins.

Our minimally invasive treatments include:

• Endovenous thermal ablation: This endovascular procedure, also called vein ablation, uses a tiny incision to reach the vein. Your vascular surgeon inserts a catheter (thin, flexible tube) into the vein and heats its tip using energy from a laser or radio waves. As the surgeon slowly pulls the catheter out, the heat seals the vein shut.
• Stab phlebectomy: Also known as ambulatory phlebectomy, this procedure removes affected veins through several tiny incisions. You can return to your daily activities right after vein removal.
• Venous angioplasty and stenting: For veins that are deep in the legs and have severe CVI, your vascular surgeon opens blockages with an endovascular procedure. Your surgeon reaches the blockage with a catheter, then inflates a balloon at its tip to widen the vein. In some cases, we may place a stent (tiny, metal-mesh tube) in the vein to hold it open.

Surgery to treat CVI

For severe CVI that doesn’t respond to other treatments, you may need open surgery. Your surgeon takes a healthy vein from elsewhere in your body and attaches it above and below the diseased section. This operation, vein bypass surgery, sends blood around the damage so it can flow back to the heart.

If you’re at risk of developing clots, you’ll likely need to keep taking blood thinners after initial treatment. Our vascular specialists help you determine how long. They provide ongoing care to protect your health, working to prevent complications such as varicose veins and DVT.

We also check blood flow in your legs at regular intervals, using ultrasound.